Provider Demographics
NPI:1356338669
Name:SEMO DRUGS INC
Entity type:Organization
Organization Name:SEMO DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:G
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-738-2098
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:SENATH
Mailing Address - State:MO
Mailing Address - Zip Code:63876-0700
Mailing Address - Country:US
Mailing Address - Phone:573-738-2097
Mailing Address - Fax:573-737-2233
Practice Address - Street 1:339 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SENATH
Practice Address - State:MO
Practice Address - Zip Code:63876-0000
Practice Address - Country:US
Practice Address - Phone:573-738-2097
Practice Address - Fax:573-738-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004198183500000X
MO045262183500000X
MO0032383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600051205Medicaid
5836540001Medicare NSC