Town & Country Grocers of Fredericktown Mo Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

006162 Issued in MO

Legal business name

TOWN & COUNTRY GROCERS OF FREDERICKTOWN MO INC

Practice address

50 Berry Rd
Bonne Terre, MO 63628-1373

Phone

(573) 358-0099

Fax

(573) 358-0084

NPI assigned

Nov 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debbie Brown

Title

Supervisor

Phone

(573) 783-5703

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• COUNTRY MART PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1164598827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 BERRY RD",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281373",
            "telephone_number": "573-358-0099",
            "fax_number": "573-358-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BERRY RD",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281373",
            "telephone_number": "573-358-0099",
            "fax_number": "573-358-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN & COUNTRY GROCERS OF FREDERICKTOWN MO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "573-783-5703"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "006162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047644",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "608853404",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COUNTRY MART PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lacey Sullivan, FNP-BC
• Katelyn Abigail Swaringim
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• Kelsie Hereora Ann Okeroa Walker
• Eric Lee Nelson Wallen, LMSW
• Jennifer D Webers

• Community/Retail Pharmacy in Bonne Terre, MO
• Providers in Bonne Terre, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.