Provider Demographics
NPI:1003800780
Name:POIRIER PHARMACY, INC
Entity Type:Organization
Organization Name:POIRIER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-324-5955
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:MO
Mailing Address - Zip Code:64485-0128
Mailing Address - Country:US
Mailing Address - Phone:816-324-5955
Mailing Address - Fax:816-324-6429
Practice Address - Street 1:102 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-1644
Practice Address - Country:US
Practice Address - Phone:816-324-5955
Practice Address - Fax:816-324-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002022436332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600307300Medicaid
MO620307306Medicaid
MO4723430001Medicare ID - Type UnspecifiedMEDICARE NUMBER
MOMA1207Medicare PIN