Provider Demographics
NPI:1760590855
Name:FORSYTH PHARMACY, INC.
Entity Type:Organization
Organization Name:FORSYTH PHARMACY, INC.
Other - Org Name:KRAMER'S FORSYTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:417-546-5151
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-0928
Mailing Address - Country:US
Mailing Address - Phone:417-546-5151
Mailing Address - Fax:417-546-4591
Practice Address - Street 1:16269 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653-7122
Practice Address - Country:US
Practice Address - Phone:417-546-5151
Practice Address - Fax:417-546-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0046403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048864OtherPK
MO600244107Medicaid
MO600244107Medicaid