Provider Demographics
NPI:1699187468
Name:OZARK LTC RX
Entity Type:Organization
Organization Name:OZARK LTC RX
Other - Org Name:OZARK LTC RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-319-1450
Mailing Address - Street 1:9 BONNEVILLE PLZ
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1307
Mailing Address - Country:US
Mailing Address - Phone:573-755-0800
Mailing Address - Fax:888-305-1276
Practice Address - Street 1:9 BONNEVILLE PLZ
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1307
Practice Address - Country:US
Practice Address - Phone:573-755-0800
Practice Address - Fax:888-305-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140155003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145749OtherPK