Provider Demographics
NPI:1790879526
Name:JOE'S PHARMACY INC
Entity Type:Organization
Organization Name:JOE'S PHARMACY INC
Other - Org Name:JOE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-532-7128
Mailing Address - Street 1:489 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3261
Mailing Address - Country:US
Mailing Address - Phone:417-532-7128
Mailing Address - Fax:417-532-9610
Practice Address - Street 1:489 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3261
Practice Address - Country:US
Practice Address - Phone:417-532-7128
Practice Address - Fax:417-532-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002683336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600585509Medicaid