Provider Demographics
NPI:1457844748
Name:TOWN AND COUNTRY SUPER MARKET INC
Entity Type:Organization
Organization Name:TOWN AND COUNTRY SUPER MARKET INC
Other - Org Name:TOWN & COUNTRY PHARMACY #688
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DRUSILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-2325
Mailing Address - Street 1:#7 HAL'S PLAZA
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957
Mailing Address - Country:US
Mailing Address - Phone:573-223-3180
Mailing Address - Fax:573-223-3074
Practice Address - Street 1:#7 HAL'S PLAZA
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957
Practice Address - Country:US
Practice Address - Phone:573-223-3180
Practice Address - Fax:573-223-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPS20180193093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy