Court Square Pharmacy, Inc
Organization Active NPI Community/Retail Pharmacy · Theodosia, MO
NPI 1386706992 · NPPES record last updated Feb 20, 2017
Key facts
- NPI
- 1386706992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2004008518 (MO)
- Legal business name
- COURT SQUARE PHARMACY, INC
- Practice address
- 4900 US Highway 160 Ste 1
Theodosia, MO 65761-6539 - Phone
- (417) 273-4555
- Fax
- (417) 273-4559
- NPI assigned
- Dec 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Craig Atkins
- Title
- Pic
- Phone
- (417) 679-2650
Corporate family (same tax ID) 1
Practitioners 1
-
Katie Kaleen Mahan, PHARM.D.
National Provider Directory
- Tax ID family
- Court Square Pharmacy Inc
Locations
4900 US Highway 160
Ste 1
Theodosia, MO 65761
Phone (417) 273-4555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2004008518 | MO | Yes |
Addresses
Primary practice location
4900 US Highway 160 Ste 1
Theodosia, MO 65761-6539
Mailing address
PO Box 353
Theodosia, MO 65761-0353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2049026 | Other | PK | |
| 606130102 | Medicaid | MO |
Other names
- THEODOSIA PHARMACY
Other providers in Theodosia, MO
- Victoria Lynne Adair
- Douglas County Public Health Services Group, Inc.
- Suzanne Marie Earl
- Tabitha Miranda Faust
- Lutie District. R-VI School
- Theodosia Medical Center
All providers in Theodosia, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.