Provider Demographics
NPI:1306989769
Name:THE DRIVE IN PHARMACY INC
Entity type:Organization
Organization Name:THE DRIVE IN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0585540001Medicare ID - Type Unspecified