Old Town Pharmacy Number 2 LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

2016027850 Issued in MO

Legal business name

OLD TOWN PHARMACY NUMBER 2 LLC

Doing business as

Old Town Pharmacy

Practice address

119 E Main St
Pierce City, MO 65723-1228

Phone

(417) 476-2828

Fax

(417) 476-5198

NPI assigned

Aug 10, 2016

Last updated

Aug 31, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shane Becker

Title

Owner

Phone

(417) 476-2828

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Old Town Pharmacy Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebecca J Becker, PHARMD

  • Pharmacist
  • Monett, MO
  • NPI 1801169578
  NPD
• Cameron T Schulte, PHARM.D.

  • Pharmacist
  • Jefferson City, MO
  • NPI 1134555766
  NPD
• Raymond Kirk

  • Pharmacist
  • Pierce City, MO
  • NPI 1093576951
  NPD (past)
• Lloyd Warner, RPH

  • Pharmacist
  • Pierce City, MO
  • NPI 1396461273
  NPD (past)

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1164976999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 E MAIN ST",
            "city": "PIERCE CITY",
            "state": "MO",
            "postal_code": "657231228",
            "telephone_number": "417-476-2828",
            "fax_number": "417-476-5198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 E MAIN ST",
            "city": "PIERCE CITY",
            "state": "MO",
            "postal_code": "657231228",
            "telephone_number": "417-476-2828",
            "fax_number": "417-476-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN PHARMACY NUMBER 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-10",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-476-2828"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": "2016027850",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162359",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Town Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandra Jo Houlihan
• Cathy Ingalls, WHNP
• Sarah Nicole Jordan
• Raymond Kirk
• Melvin D Hodde DO LLC (Pierce City Medical Clinic)
• Christy K Ostrosky
• School Dist R6 Pierce City
• The Arc of the Ozarks
• Thompson Family Drug
• Lloyd Warner, RPH

• Pharmacy in Pierce City, MO
• Providers in Pierce City, MO by specialty
• Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.