Provider Demographics
NPI:1831258839
Name:TOWN AND COUNTRY GROCERS OF FREDERICKTOWN MO INC
Entity type:Organization
Organization Name:TOWN AND COUNTRY GROCERS OF FREDERICKTOWN MO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-783-5703
Mailing Address - Street 1:301 T J STEWART DR
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2500
Mailing Address - Country:US
Mailing Address - Phone:573-431-8537
Mailing Address - Fax:573-431-2514
Practice Address - Street 1:301 T J STEWART DR
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2500
Practice Address - Country:US
Practice Address - Phone:573-431-8537
Practice Address - Fax:573-431-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060359693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2637265OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MO1253710006Medicare NSC