1790835874 NPI number — KULER DRUGS LLC

Table of content: (NPI 1790835874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790835874 NPI number — KULER DRUGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KULER DRUGS LLC
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:
MED DEPOT 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:
1790835874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63501-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-665-7239
Provider Business Mailing Address Fax Number:
660-665-6474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-665-7239
Provider Business Practice Location Address Fax Number:
660-665-6474
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KUTTENKULER
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
660-665-7239

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  004752 , 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: 601504608 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".