Saults Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

004787 Issued in MO

Legal business name

SAULTS DRUG STORE INC

Doing business as

SAULTS DRUG STORE INC

Practice address

505 Court St
Fulton, MO 65251-1901

Phone

(573) 642-4186

Fax

(573) 642-8324

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

Alton Real, RPH

Title

Owner,RPH,Ao

Phone

(573) 642-4186

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SAULTS DRUG STORE INC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

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

• Mackenzie Davis-Henley

  • Pharmacist
  • Fulton, MO
  • NPI 1831011253
  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": "1489968000000",
    "number": "1609887116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 COURT ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511901",
            "telephone_number": "573-642-4186",
            "fax_number": "573-642-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 COURT ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511901",
            "telephone_number": "573-642-4186",
            "fax_number": "573-642-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULTS DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2017-03-20",
        "status": "A",
        "authorized_official_last_name": "REAL",
        "authorized_official_first_name": "ALTON",
        "authorized_official_title_or_position": "OWNER,RPH,AO",
        "authorized_official_telephone_number": "573-642-4186",
        "authorized_official_credential": "RPH"
    },
    "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": "004787",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600053409",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048868",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAULTS DRUG STORE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Marie Rulo, SMFT, PLPC
• Cynthia L. Russell, PT
• Safe Care, LLC
• Kathyrn Salmons
• Karanbir Sandhu, DDS
• Devon Schmitz, MAS, LAT, ATC
• Megan Searles, OTR/L
• Second Chance Homes of Fulton LLC
• Rebecca Marie Seitz, MSW, LCSW
• Jessica Ashley Sergio, PH.D.

• Community/Retail Pharmacy in Fulton, MO
• Providers in Fulton, 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 Mar 20, 2017; 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.

Verify at the official NPI Registry.