Provider Demographics
NPI:1508965534
Name:PERRYVILLE HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:PERRYVILLE HEALTHCARE CORPORATION
Other - Org Name:PRESCRIPTIONS PLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-547-4960
Mailing Address - Street 1:212 HOSPITAL LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-547-4960
Mailing Address - Fax:573-547-6540
Practice Address - Street 1:212 HOSPITAL LN STE 102
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-4204
Practice Address - Country:US
Practice Address - Phone:573-547-4960
Practice Address - Fax:573-547-6540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY COUNTY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006636333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO604688606Medicaid
MO2632722OtherNABP NUMBER
MOBP6468688OtherDEA NUMBER
MOBP6468688OtherDEA NUMBER