1336137108 NPI number — A & R PHARMACY II, INC.

Table of content: (NPI 1336137108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336137108 NPI number — A & R PHARMACY II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & R PHARMACY II, 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:
Provider Other Organization Name Type Code:
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:
1336137108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 E MILL ST
Provider Second Line Business Mailing Address:
STE. A
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64068-1852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-415-9995
Provider Business Mailing Address Fax Number:
816-415-4742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 E MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-415-9995
Provider Business Practice Location Address Fax Number:
816-415-4742
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STUTE
Authorized Official First Name:
ASHTON
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
816-415-9995

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2003007191 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 2202348 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 626145205 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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