Southeast Health Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2013001184 Issued in MO

Legal business name

SOUTHEAST HEALTH PHARMACY LLC

Doing business as

SoutheastHEALTH Pharmacy

Practice address

2002 Kanell Blvd
Ste 102
Poplar Bluff, MO 63901-4045

Phone

(573) 778-1608

Fax

(573) 778-1645

NPI assigned

Apr 29, 2013

Last updated

Feb 3, 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

Mike McAfee

Title

Pic

Phone

(573) 778-1608

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SoutheastHEALTH Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454457600000",
    "number": "1396189767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 989",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639020989",
            "telephone_number": "573-778-1608",
            "fax_number": "573-778-1645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 KANELL BLVD",
            "address_2": "STE 102",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014045",
            "telephone_number": "573-778-1608",
            "fax_number": "573-778-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HEALTH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-02-03",
        "status": "A",
        "authorized_official_last_name": "MCAFEE",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "573-778-1608"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2013001184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140112",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SoutheastHEALTH Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Poplar Bluff, MO
• Providers in Poplar Bluff, 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 Feb 3, 2016; 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.