Active NPI
Health Care Pharmacy of Perryville, LLC
Doing business as Healthcare Healthwise Pharmacy
- Community/Retail Pharmacy
- Perryville, MO
National Provider Identifier
1427199090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 2017038581
- Legal business name
- HEALTH CARE PHARMACY OF PERRYVILLE, LLC
- Doing business as
- Healthcare Healthwise Pharmacy
- Practice address
- 628 Old Saint Marys Rd
Perryville, MO 63775-1837 - Phone
- (573) 547-2517
- Fax
- (573) 547-7758
- NPI assigned
- Feb 8, 2007
- Last updated
- Dec 3, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Savanna Grogg
- Title
- Manager
- Phone
- (573) 535-4911
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 2017038581 | MO | Primary |
Addresses
Primary practice location
628 Old Saint Marys Rd
Perryville, MO 63775-1837
Mailing address
628 N. Old St. Marys Road
Perryville, MO 63775
Phone (573) 547-2517
Other names 1
- Healthcare Healthwise Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210119000742 | MO | Part B Supplier - Pharmacy | 2466865175 | Practice locations: Perryville, MO |
National Provider Directory
National Provider Directory- Tax ID family
- Health Care Pharmacy of Perryville LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Healthcare Healthwise Pharmacy
- Long Term Care Pharmacy
- Perryville, MO
- NPI 1902461908
Locations
630 Old Saint Marys Rd
Perryville, MO 63775
Phone (573) 547-2517
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1638489600000",
"number": "1427199090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 N. OLD ST. MARYS ROAD",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "63775",
"telephone_number": "573-547-2517",
"fax_number": "573-547-7758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 OLD SAINT MARYS RD",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "637751837",
"telephone_number": "573-547-2517",
"fax_number": "573-547-7758"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTH CARE PHARMACY OF PERRYVILLE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-08",
"last_updated": "2021-12-03",
"certification_date": "2021-12-03",
"status": "A",
"authorized_official_last_name": "GROGG",
"authorized_official_first_name": "SAVANNA",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "573-535-4911",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MO",
"license": "2017038581",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Healthcare Healthwise Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Perryville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.