Provider Demographics
NPI:1215010095
Name:EAST MISSOURI PHARMACY SERVICES, LLC
Entity Type:Organization
Organization Name:EAST MISSOURI PHARMACY SERVICES, LLC
Other - Org Name:TWIN CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOKERST
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:636-937-8228
Mailing Address - Street 1:1447 U.S. HIGHWAY 61
Mailing Address - Street 2:SUITE A
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-937-8228
Mailing Address - Fax:636-937-8746
Practice Address - Street 1:1447 U.S. HIGHWAY 61
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-937-8228
Practice Address - Fax:636-937-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy