Provider Demographics
NPI:1861638314
Name:JMC PHARMACIES, LLC.
Entity Type:Organization
Organization Name:JMC PHARMACIES, LLC.
Other - Org Name:UVANTA PHARMACY- SOUTHERN MISSOURI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-894-8144
Mailing Address - Street 1:2103 E ROCKHURST ST
Mailing Address - Street 2:STE 108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-6522
Mailing Address - Country:US
Mailing Address - Phone:417-864-5873
Mailing Address - Fax:417-864-5874
Practice Address - Street 1:2103 E ROCKHURST ST STE 108
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6501
Practice Address - Country:US
Practice Address - Phone:417-864-5873
Practice Address - Fax:417-864-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20090000593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118445OtherPK