Provider Demographics
NPI:1255407912
Name:BARTHOLOMEW DRUG COMPANY
Entity type:Organization
Organization Name:BARTHOLOMEW DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-335-3375
Mailing Address - Street 1:315 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK PORT
Mailing Address - State:MO
Mailing Address - Zip Code:64482-1533
Mailing Address - Country:US
Mailing Address - Phone:660-744-2343
Mailing Address - Fax:660-744-2433
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK PORT
Practice Address - State:MO
Practice Address - Zip Code:64482-1533
Practice Address - Country:US
Practice Address - Phone:660-744-2343
Practice Address - Fax:660-744-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 332B00000X, 3336C0003X
MO002402333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO60007406Medicaid
2609723OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0594750001Medicare ID - Type Unspecified