Provider Demographics
NPI:1326234329
Name:STOCKSTILLS PHARMACY INC
Entity Type:Organization
Organization Name:STOCKSTILLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKSTILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-765-3321
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0310
Mailing Address - Country:US
Mailing Address - Phone:573-765-3321
Mailing Address - Fax:573-765-5200
Practice Address - Street 1:104 W MCCLURG AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556
Practice Address - Country:US
Practice Address - Phone:573-765-3321
Practice Address - Fax:573-765-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040065193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600284509Medicaid
MA2727Medicare PIN