Provider Demographics
NPI:1962448472
Name:GOSNEY PHARMACY INC
Entity Type:Organization
Organization Name:GOSNEY PHARMACY INC
Other - Org Name:GOSNEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-795-2304
Mailing Address - Street 1:911 HIGHWAY 24/36 EAST
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63456
Mailing Address - Country:US
Mailing Address - Phone:573-735-1130
Mailing Address - Fax:573-735-4831
Practice Address - Street 1:911 HIGHWAY 24/36 EAST
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:MO
Practice Address - Zip Code:63456
Practice Address - Country:US
Practice Address - Phone:573-735-1130
Practice Address - Fax:573-735-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20140437223336C0003X
MO40424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047522OtherPK
MO6082722902Medicaid