Mountain Grove Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2015006569 Issued in MO

Legal business name

MOUNTAIN GROVE PHARMACY INC

Practice address

106 N Union St
Mountain Grove, MO 65711-1724

Phone

(417) 926-4156

Fax

(417) 926-4125

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Christine CoffmanNPI 1124777362

Title

Pic

Phone

(417) 926-9655

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MOUNTAIN GROVE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

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

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christine Michelle Coffman, RPH

  • Pharmacist
  • Mountain Grove, MO
  • NPI 1124777362
  NPD Authorized official
• Bailey Adler, PHARMD

  • Pharmacist
  • Mountain Grove, MO
  • NPI 1316722051
  NPD (past)
• Brock Coffman

  • Pharmacist
  • Mountain Grove, MO
  • NPI 1215812664
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1285645820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N UNION ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111724",
            "telephone_number": "417-926-4156",
            "fax_number": "417-926-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N UNION ST",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111724",
            "telephone_number": "417-926-4156",
            "fax_number": "417-926-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN GROVE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "COFFMAN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "417-926-9655"
    },
    "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": "2015006569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601091507",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049297",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNTAIN GROVE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Douglas Loran Moore, OD
• Jade Moore, APRN, FNP-C
• Mountain Grove 2 Inc
• Mountain Grove Medical and Laser Center Inc
• Mountain Grove Medical and Laser Center Inc
• Mountain Grove R-III School District
• Ashley Myers, LMSW
• Laney Ness
• Meagan Renee Newberry
• Samuel Aaron Newton, MD

• Community/Retail Pharmacy in Mountain Grove, MO
• Providers in Mountain Grove, 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 Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.