STATE OF MISSOURI (NPI# 1669511093) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669511093 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | SOUTHEAST MISSOURI MENTAL HEALTH CENTER PHARMACY |
| Practice Address |
1010 W Columbia St Farmington MO 63640-2902 |
| Practice Telephone | 5732186759 |
| Practice Fax Number | 5732186762 |
| Mailing Telephone | 5732186759 |
| Mailing Fax Number | 5732186762 |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-28 |
| Authorized Official Name | MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Telephone | 5737514055 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
001820 | MO | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 050490200 | 05 | |
| PK | 2048857 | 01 |
| Other Name | Type Code |
|---|---|
| SOUTHEAST MISSOURI MENTAL HEALTH CENTER PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437781499 | State of Missouri | Rehabilitation Counselor | 3418 Knipp Dr, Jefferson City, MO 65109-5701 | 2020-02-07 |
| 1275073280 | State of Missouri | General Practice | 1547 W Commerce Drive, Marshall, MO 65340-3907 | 2017-02-24 |
| 1528333085 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 N Colorado St, Nevada, MO 64772-1618 | 2012-03-16 |
| 1386843621 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15555 Little Blue Rd, Kansas City, MO 64139 | 2007-07-17 |
| 1922207679 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5410 Rinker Rd, Kansas City, MO 64129-2308 | 2007-07-13 |
| 1760681415 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1501 N River Blvd, Independence, MO 64050-1760 | 2007-07-13 |
| 1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
| 1548322605 | State of Missouri | Day Training, Developmentally Disabled Services | 1500 Vandiver Dr Ste 100, Columbia, MO 65202-3932 | 2006-12-15 |
| 1366503153 | State of Missouri | Day Training, Developmentally Disabled Services | 471 E Slater St, Marshall, MO 65340 | 2006-12-13 |
| 1427118033 | State of Missouri | Day Training, Developmentally Disabled Services | 522 Star St, Marshall, MO 65340 | 2006-12-12 |
| Street Address |
1010 W COLUMBIA ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-2902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114909801 | Michael James Mccarver | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2005-11-17 |
| 1437768025 | Taylor Cook | Dietitian, Registered | 1010 W Columbia St, Farmington, MO 63640-2902 | 2020-07-29 |
| 1265846307 | Jamie Barton | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2014-06-17 |
| 1285050526 | Joshua Herwig | Nurse Practitioner | 1010 W Columbia St, Farmington, MO 63640-2902 | 2014-03-11 |
| 1447671052 | Jacquelyn Kathleen Rudolph | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2013-12-27 |
| 1912206087 | Ismar Karadzic | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2011-03-15 |
| 1902104177 | Mark Aaron Anderson | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2011-03-11 |
| 1568779189 | Michael Martin Luther Krownapple | Psychologist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2010-09-02 |
| 1629308002 | Gary L Thomas | Pharmacist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2010-01-06 |
| 1245566611 | Thomas Stanley Finley I | Dentist | 1010 W Columbia St, Farmington, MO 63640-2902 | 2009-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 3336I0012X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Institutional Pharmacy |
| A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386015709 | Truman Medical Center, Incorporated | Pharmacy | 2101 Charlotte, Kansas City, MO 64108 | 2015-10-12 |
| 1194978924 | Wellfount Corporation | Pharmacy | 103 Borga Building, Festus, MO 63028-1136 | 2008-10-24 |
| 1679594626 | Nutritional Support Services | Pharmacy | 1329 Horan Dr, Fenton, MO 63026-1939 | 2006-07-22 |
| 1780891895 | Lester E. Cox Medical Center | Pharmacy | 1423 N Jefferson Ave, Springfield, MO 65802-1917 | 2007-05-17 |
| 1942316708 | Carroll Cnty Mem Hosp Pharmacy Inc | Pharmacy | 1502 N Jefferson St, Carrollton, MO 64633-1948 | 2006-08-22 |
| 1912926858 | Hannibal Regional Heathcare System, Inc | Pharmacy | 6000 Hospital Drive, Hannibal, MO 63401 | 2006-07-19 |
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on STATE OF MISSOURI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.