Provider Demographics
NPI:1134119043
Name:THE DRIVE-IN PHARMACY INC.
Entity Type:Organization
Organization Name:THE DRIVE-IN PHARMACY INC.
Other - Org Name:DRIVE-IN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-581-6450
Mailing Address - Street 1:200 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2821
Mailing Address - Country:US
Mailing Address - Phone:573-581-6450
Mailing Address - Fax:573-581-4692
Practice Address - Street 1:200 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2821
Practice Address - Country:US
Practice Address - Phone:573-581-6450
Practice Address - Fax:573-581-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO026810333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10907OtherSTATE BNDD NO.
MO026810OtherMO.PHARMACY LICENSE
MOAT2958354OtherFED DEA NO.
MO0585540001Medicare ID - Type UnspecifiedMEDICARE NO.