Provider Demographics
NPI:1205189040
Name:GOSNEY PHARMACY INC
Entity Type:Organization
Organization Name:GOSNEY PHARMACY INC
Other - Org Name:GOSNEY PHARMACY LTC
Other - Org Type:Other Name
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GSONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-248-8322
Mailing Address - Street 1:2900 SAINT MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3715
Mailing Address - Country:US
Mailing Address - Phone:573-248-8322
Mailing Address - Fax:
Practice Address - Street 1:2900 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3715
Practice Address - Country:US
Practice Address - Phone:573-248-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO60173336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO608272902Medicaid