Provider Demographics
NPI:1225112345
Name:TOWN PHARMACY INC.
Entity Type:Organization
Organization Name:TOWN PHARMACY INC.
Other - Org Name:TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-568-2643
Mailing Address - Street 1:P.O. BOX 337
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63825
Mailing Address - Country:US
Mailing Address - Phone:573-568-2643
Mailing Address - Fax:573-568-3281
Practice Address - Street 1:700 HIGHWAY 25 SOUTH
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825
Practice Address - Country:US
Practice Address - Phone:573-568-2643
Practice Address - Fax:573-568-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005267333600000X
MO3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621504109Medicaid
MO601504103Medicaid
MO0662510001Medicare NSC