Basic Information
| Provider Information | |||||||||
| NPI: | 1659616225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SWEET SPRINGS PHARMACY INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARCELINE FAMILY PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 737 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646010737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607070906 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1509 N MISSOURI AVE | ||||||||
| Address2: | |||||||||
| City: | MARCELINE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603762700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2012 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6602471580 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | MO | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 5576550001 | 01 | MO | MEDICARE PTAN | OTHER |