Provider Demographics
NPI:1427524594
Name:TOWN AND COUNTRY SUPER MARKET , INC
Entity type:Organization
Organization Name:TOWN AND COUNTRY SUPER MARKET , INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/CORP .SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DRUSILLA
Authorized Official - Middle Name:ZOANN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-2325
Mailing Address - Street 1:604-A E. SOUTH ST.
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721
Mailing Address - Country:US
Mailing Address - Phone:417-581-7777
Mailing Address - Fax:417-581-3998
Practice Address - Street 1:604 E SOUTH ST STE A
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8912
Practice Address - Country:US
Practice Address - Phone:417-581-7777
Practice Address - Fax:417-581-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600129001Medicaid