Provider Demographics
NPI:1912506437
Name:E HEALTH PHARMACY, LLC
Entity Type:Organization
Organization Name:E HEALTH PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-414-5495
Mailing Address - Street 1:1173 E HINES ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1277
Mailing Address - Country:US
Mailing Address - Phone:417-414-5495
Mailing Address - Fax:
Practice Address - Street 1:411D NORTHVIEW RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8679
Practice Address - Country:US
Practice Address - Phone:417-414-5495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy