Provider Demographics
NPI:1376524959
Name:CLEARWATER HEALTH RESOURCES INC
Entity Type:Organization
Organization Name:CLEARWATER HEALTH RESOURCES INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-223-4235
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-0278
Mailing Address - Country:US
Mailing Address - Phone:573-223-4235
Mailing Address - Fax:573-223-4184
Practice Address - Street 1:RR 4 BOX 4515
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-9417
Practice Address - Country:US
Practice Address - Phone:573-223-4235
Practice Address - Fax:573-223-4184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARWATER HEALTH RESOURCES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0065853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2609381OtherNCPDP
MO600118608Medicaid