Provider Demographics
NPI:1396895611
Name:MAIN SAIL ENTERPRISES LLC
Entity type:Organization
Organization Name:MAIN SAIL ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-548-7184
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:SARCOXIE
Mailing Address - State:MO
Mailing Address - Zip Code:64862-0267
Mailing Address - Country:US
Mailing Address - Phone:417-548-7184
Mailing Address - Fax:417-548-7404
Practice Address - Street 1:1408 HIGH ST
Practice Address - Street 2:
Practice Address - City:SARCOXIE
Practice Address - State:MO
Practice Address - Zip Code:64862-8323
Practice Address - Country:US
Practice Address - Phone:417-548-7184
Practice Address - Fax:417-548-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120105193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2631770OtherNCPDP PROVIDER IDENTIFICATION NUMBER