POPLAR BLUFF PHARMACY (2870)    INSTITUTION (4)

Name Value
NAME POPLAR BLUFF PHARMACY
STATE MISSOURI
STREET ADDR. 1 1500 North Westwood Blvd.
CITY Poplar Bluff
ZIP 63901-3318
OFFICIAL VA NAME Poplar Bluff Pharmacy
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME POPLAR BLUFF VAMC PHARMACY
ST. ADDR. 1 (MAILING) 1500 North Westwood Blvd.
CITY (MAILING) Poplar Bluff
STATE (MAILING) MISSOURI
ZIP (MAILING) 63901-3318
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1588622880
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1588622880