Physician Park Investment Company

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

2008022112 Issued in MO

Legal business name

PHYSICIAN PARK INVESTMENT COMPANY

Doing business as

Physicians Park Pharmacy LTC

Practice address

225 Physicians Park
Ste 100a
Poplar Bluff, MO 63901-3956

Phone

(573) 778-9238

Fax

(573) 778-9582

NPI assigned

Aug 14, 2008

Organization subpart

No

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

Authorized official

Name

Roy Winters

Title

Pic

Phone

(573) 778-9238

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Physicians Park Pharmacy LTC Doing business as

Locations

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252800000000",
    "number": "1780830455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK",
            "address_2": "STE 100A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-778-9238",
            "fax_number": "573-778-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK",
            "address_2": "STE 100A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-778-9238",
            "fax_number": "573-778-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN PARK INVESTMENT COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-14",
        "last_updated": "2009-09-13",
        "status": "A",
        "authorized_official_last_name": "WINTERS",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "573-778-9238"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2008022112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2638142",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Park Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suwan Phanijphand, MD
• Astasia Estell Phelps
• Daniel Travis Phillips, LCSW
• Darby Blake Phillips, FNP-C
• Mackenzie Phillips
• Alyssa Nicole Pickens
• Abigail Pierce, OD
• Andrea Pierce, MSN, RN
• Kelli A. Pierce, SLP
• William R Pierce, M.D.

• Long Term Care Pharmacy in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Long Term Care Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2009; 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.