Provider Demographics
NPI:1609911643
Name:E & S PHARMACY INC
Entity Type:Organization
Organization Name:E & S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-996-7157
Mailing Address - Street 1:1105 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1339
Mailing Address - Country:US
Mailing Address - Phone:573-996-7157
Mailing Address - Fax:573-996-7526
Practice Address - Street 1:1105 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1339
Practice Address - Country:US
Practice Address - Phone:573-996-7157
Practice Address - Fax:573-996-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO622040004Medicaid
MO622040004Medicaid