NPIMap

Organization Active NPI

Sam'S Prescription Shop, Inc.

  • Long Term Care Pharmacy
  • Moberly, MO
National Provider Identifier
1659987584
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
SAM'S PRESCRIPTION SHOP, INC.
Practice address
300 N Morley St
Moberly, MO 65270-2334
Phone
(660) 263-0909
Fax
(660) 263-2124
NPI assigned
Sep 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Christian S Tadrus
Title
Officer
Phone
(660) 263-3309

Specialties & licenses 1

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

Addresses

Primary practice location

300 N Morley St
Moberly, MO 65270-2334

Mailing address

PO Box 957
Moberly, MO 65270-0957
Phone (660) 263-3309

Other identifiers 2

IdentifierTypeStateIssuer
600061105MedicaidMO
620061101MedicaidMO

Other names 1

  • Sam's Health Mart Pharmacy # 1 (Long Term Care) Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sam'S Health Mart Pharmacy6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1659987584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 957",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652700957",
            "telephone_number": "660-263-3309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MORLEY ST",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652702334",
            "telephone_number": "660-263-0909",
            "fax_number": "660-263-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM'S PRESCRIPTION SHOP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "TADRUS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "660-263-3309"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600061105",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620061101",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Health Mart Pharmacy # 1 (Long Term Care)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moberly, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.