1740298132 NPI number — MACKS GROCERY INC

Table of content: (NPI 1740298132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740298132 NPI number — MACKS GROCERY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACKS GROCERY 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:
PARKERS NORTH PHARMACY
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:
1740298132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENSBURG
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64093-7146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-422-7050
Provider Business Mailing Address Fax Number:
660-422-7052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 E RUSSELL AVE BLDG C
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WARRENSBURG
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64093-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-422-7050
Provider Business Practice Location Address Fax Number:
660-422-7052
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMURPHY
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
660-422-7050

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2004026484 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2635689 . This is a "NCPDP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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