Vandivort Drug

LBN: Wisdom Drug Llc
Vandivort Drug is an health care organization with primary practice located at 117 W 4Th St , Salem MO 65560-1255. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Wisdom Drug Llc can be contacted via phone (573) 729-4114, or through Wisdom, Teel Ryan via phone (573) 729-4114.

Contact Information

Primary practice address
117 W 4Th St Salem MO 65560-1255
Phone: (573) 729-4114
Fax: (573) 729-5353
Website:
Map and Directions
Authorized official contact:
Name: Wisdom, Teel Ryan
Phone: (573) 729-4114

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X PS 004855 Missouri
Suppliers / Long Term Care Pharmacy 3336L0003X

Profile Details

NPI number 1225072093
LBN Legal business name Wisdom Drug Llc
DBA Doing business as Vandivort Drug
Authorized official Wisdom, Teel Ryan
Entity Organization
Organization subpart 1 No
Enumeration date Jun 15th, 2006
Last updated Feb 14th, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225072093 NPPES
Missouri MEDICAID 600126916

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