1518956093 NPI number — PLEASANT HILL DRUG STORE INC

Table of content: (NPI 1518956093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518956093 NPI number — PLEASANT HILL DRUG STORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLEASANT HILL DRUG STORE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PLEASANT HILL DRUG STORE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518956093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 N 7 HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64080-9366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-540-4000
Provider Business Mailing Address Fax Number:
816-540-4341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 N STATE ROUTE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64080-9366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-540-4000
Provider Business Practice Location Address Fax Number:
816-540-4341
Provider Enumeration Date:
10/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEFEVER
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/PRESIDENT
Authorized Official Telephone Number:
913-515-0462

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2002009963 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 628237802 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608237806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2048807 . This is a "PK" identifier . This identifiers is of the category "OTHER".