NPIMap

Organization Active NPI

St. John's Physician & Clinic

Doing business as St. John's Sisk Pharmacy

  • Pharmacist
  • Licking, MO
National Provider Identifier
1790978765
Registry record updated Aug 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
006040 Issued in MO
Legal business name
ST. JOHN'S PHYSICIAN & CLINIC
Doing business as
St. John's Sisk Pharmacy
Practice address
101 North Main Street
Licking, MO 65542
Phone
(573) 674-2922
Fax
(573) 674-4334
NPI assigned
Aug 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2007

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

Authorized official

Name
Mr. Rob Shockley
Title
Retail Coordinator
Phone
(417) 820-6624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 006040 MO Primary

Addresses

Primary practice location

101 North Main Street
Licking, MO 65542

Mailing address

101 North Main Street
Licking, MO 65542
Phone (573) 674-2922

Other names 1

  • St. John's Sisk Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Springfield Clinic Nucl55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1790978765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NORTH MAIN STREET",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "65542",
            "telephone_number": "573-674-2922",
            "fax_number": "573-674-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NORTH MAIN STREET",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "65542",
            "telephone_number": "573-674-2922",
            "fax_number": "573-674-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S PHYSICIAN & CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "RETAIL COORDINATOR",
        "authorized_official_telephone_number": "417-820-6624",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "006040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Sisk Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Licking, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; 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.