Provider Demographics
NPI:1619082658
Name:E & S PHARMACY INC
Entity Type:Organization
Organization Name:E & S PHARMACY INC
Other - Org Name:E & S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST/CORPORATE SECRETAR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
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:2006-08-20
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO0043013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO622040004Medicaid
2050494OtherPK
MO602020008Medicaid
MO602020008Medicaid