1801104484 NPI number — CLEVER PHARMACY INC

Table of content: (NPI 1801104484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801104484 NPI number — CLEVER PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVER PHARMACY 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:
CLEVER 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:
1801104484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 S ELLIOTT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65605-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-678-2260
Provider Business Mailing Address Fax Number:
417-678-2270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7450D STATE HIGHWAY 14 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65610-9094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-743-5200
Provider Business Practice Location Address Fax Number:
417-743-5202
Provider Enumeration Date:
09/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER-MORRISON
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SEC/TREAS
Authorized Official Telephone Number:
417-678-2260

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2010036608 , 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: 2639358 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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