Provider Demographics
NPI:1407300999
Name:HERMANN FAMILY LLC
Entity Type:Organization
Organization Name:HERMANN FAMILY LLC
Other - Org Name:HERMANN FAMILY DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THUY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-486-2873
Mailing Address - Street 1:195 STATE HIGHWAY 100 W
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-1577
Mailing Address - Country:US
Mailing Address - Phone:573-486-2873
Mailing Address - Fax:573-486-5463
Practice Address - Street 1:195 STATE HIGHWAY 100 W
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1577
Practice Address - Country:US
Practice Address - Phone:573-486-2873
Practice Address - Fax:573-486-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20160286023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162557OtherPK