Provider Demographics
NPI:1376714014
Name:ARCADIA VALLEY DRUG CO
Entity Type:Organization
Organization Name:ARCADIA VALLEY DRUG CO
Other - Org Name:SOUTHEAST MISSOURI QUALITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCE JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-492-4662
Mailing Address - Street 1:1351 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2066
Mailing Address - Country:US
Mailing Address - Phone:573-760-0033
Mailing Address - Fax:573-760-0521
Practice Address - Street 1:1351 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2066
Practice Address - Country:US
Practice Address - Phone:573-760-0333
Practice Address - Fax:573-760-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080046613336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049633OtherPK
MO136714014Medicaid
MO136714014Medicaid