Provider Demographics
NPI:1053425025
Name:ASH GROVE PHARMACY INC
Entity type:Organization
Organization Name:ASH GROVE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-751-2111
Mailing Address - Street 1:490 N MEDICAL DR
Mailing Address - Street 2:PO BOX 417
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-1004
Mailing Address - Country:US
Mailing Address - Phone:417-751-2111
Mailing Address - Fax:417-751-3112
Practice Address - Street 1:490 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-1004
Practice Address - Country:US
Practice Address - Phone:417-751-2111
Practice Address - Fax:417-751-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO0044653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601689003Medicaid
2050250OtherPK
5616150001Medicare NSC