NPIMap

Organization Active NPI

Old Town Pharmacy LLC

  • Long Term Care Pharmacy
  • Monett, MO
National Provider Identifier
1437789237
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
OLD TOWN PHARMACY LLC
Practice address
100 Chapel Dr Ste a
Monett, MO 65708-9378
Phone
(417) 635-1100
NPI assigned
Jan 21, 2020
Last updated
Jan 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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

Authorized official

Name
Mr. Kelly M Hall, RPH
Title
Vice President of Operations
Phone
(417) 635-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

100 Chapel Dr Ste a
Monett, MO 65708-9378

Mailing address

100 Chapel Dr Ste a
Monett, MO 65708-9378
Phone (417) 635-1100

National Provider Directory

National Provider Directory
Tax ID family
Old Town Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1437789237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHAPEL DR STE A",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657089378",
            "telephone_number": "417-635-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CHAPEL DR STE A",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657089378",
            "telephone_number": "417-635-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "417-635-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.