Main Street Medical Pharmacy, LLC
Organization Active NPI Community/Retail Pharmacy · Gallatin, MO
NPI 1851957955 · NPPES record last updated May 14, 2019
Key facts
- NPI
- 1851957955
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- MAIN STREET MEDICAL PHARMACY, LLC
- Practice address
- 403 S Main St
Gallatin, MO 64640-1434 - Phone
- (660) 663-7979
- Fax
- (660) 663-2963
- NPI assigned
- May 14, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Nicole McHargue Neal, PHARMD
- Title
- Owner, Pic
- Phone
- (660) 663-7979
Practitioners 2
-
Nicole McHargue Neal, PHARMD
-
Mackenzie Lane Morrison, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2204285 | Main Street Medical Pharmacy, LLC | Certificate of waiver | Dec 7, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191127000222 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 3971835067 | Practice locations: Gallatin, MO |
National Provider Directory
Locations
403 S Main St
Gallatin, MO 64640
Phone (660) 663-7979
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
403 S Main St
Gallatin, MO 64640-1434
Mailing address
403 S Main St
Gallatin, MO 64640-1434
Phone (660) 663-7979
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2500053920 | Other | MO | BNDD LICENSE |
| 2019013549 | Other | MO | MISSOURI STATE BOARD OF PHARMACY PERMIT |
Other providers in Gallatin, MO
- Stanley Earl Humphrey
- Ip Reserve
- Ip Reserve
- Kristina Renee Lee
- Zachery C. Mahler
- Mackenzie Lane Morrison
- Nicole McHargue Neal
- Northwest Health Services Inc
- Northwest Health Services Inc
- Northwest Health Services Inc
All providers in Gallatin, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.