NPIMap

Organization Active NPI

Sam'S Prescription Shop, Inc.

  • Community/Retail Pharmacy
  • Moberly, MO
National Provider Identifier
1245709682
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SAM'S PRESCRIPTION SHOP, INC.
Practice address
300 N. Morley Street
Moberly, MO 65270
Phone
(660) 263-0909
Fax
(660) 263-2124
NPI assigned
Nov 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Christian S Tadrus
Title
Officer
Phone
(660) 263-3309

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pharmacology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208U00000X
Clinical Medical Laboratory 291U00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Nursing Facility Supplies (DME) 332BN1400X
Hearing Aid Equipment 332S00000X
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

300 N. Morley Street
Moberly, MO 65270

Mailing address

PO Box 957
Moberly, MO 65270-0957
Phone (660) 263-3309

Other practice location 1

300 N. Church Street
Fayette, MO 65248
Phone (660) 248-2275

Other practice location 2

530 E. 24 Highway
Moberly, MO 65270
Phone (660) 263-6710

Other identifiers 2

IdentifierTypeStateIssuer
MA3507OtherMEDICARE MASS IMMUNIZATION BILLING NUMBER
10735224OtherMOMISSOURI TAX ID NUMBER

Other names 1

  • Sam's Health Mart Pharmacies Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sam'S Health Mart Pharmacy6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1245709682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 957",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652700957",
            "telephone_number": "660-263-3309",
            "fax_number": "660-263-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N. MORLEY STREET",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "65270",
            "telephone_number": "660-263-0909",
            "fax_number": "660-263-2124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 N. Church Street",
            "address_purpose": "LOCATION",
            "city": "Fayette",
            "state": "MO",
            "postal_code": "65248",
            "country_code": "US",
            "telephone_number": "660-248-2275",
            "fax_number": "660-248-2858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 E. 24 Highway",
            "address_purpose": "LOCATION",
            "city": "Moberly",
            "state": "MO",
            "postal_code": "65270",
            "country_code": "US",
            "telephone_number": "660-263-6710",
            "fax_number": "660-263-2269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAM'S PRESCRIPTION SHOP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "TADRUS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "660-263-3309"
    },
    "taxonomies": [
        {
            "code": "208U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Pharmacology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MASS IMMUNIZATION BILLING NUMBER",
            "identifier": "MA3507",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI TAX ID NUMBER",
            "identifier": "10735224",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Health Mart Pharmacies",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Health Mart Pharmacies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moberly, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.