Main Street Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2013000674 Issued in MO

Legal business name

MAIN STREET PHARMACY LLC

Practice address

117 E Main St
East Prairie, MO 63845-1136

Phone

(573) 649-9229

Fax

(573) 649-9230

NPI assigned

Feb 26, 2007

Organization subpart

No

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

Authorized official

Name

Tera Johnson

Title

Manager

Phone

(573) 649-9229

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MAIN STREET PHARMACY Doing business as

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1689700379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E MAIN ST",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "638451136",
            "telephone_number": "573-649-9229",
            "fax_number": "573-649-9230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E MAIN ST",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "638451136",
            "telephone_number": "573-649-9229",
            "fax_number": "573-649-9230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TERA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-649-9229"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2013000674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048743",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605420405",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Claire E Grisham, FNP
• Rebecca Camille Hatton, COTA/L
• Jimmy D. Heath Jr., M.D.
• Patricia Hogan, RPH
• Bryan Hubbard, PHARMD.
• Main Street Pharmacy LLC.
• Main Street RX
• Main Street RX, LLC
• Susan Myrick Marshall, PHARMD
• Teresa Leann Morris, LCSW

• Community/Retail Pharmacy in East Prairie, MO
• Providers in East Prairie, 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 9, 2015; 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.