Provider Demographics
NPI:1588042816
Name:MAIN SAIL ENTERPRISES-DOWNTOWN LLC
Entity Type:Organization
Organization Name:MAIN SAIL ENTERPRISES-DOWNTOWN LLC
Other - Org Name:DBA DOWNTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-343-0635
Mailing Address - Street 1:2101 W CHESTERFIELD BLVD
Mailing Address - Street 2:SUITE C100-125
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6946
Mailing Address - Country:US
Mailing Address - Phone:417-343-0635
Mailing Address - Fax:
Practice Address - Street 1:655 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2901
Practice Address - Country:US
Practice Address - Phone:417-343-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150122883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy