1477659779 NPI number — ADRIAN KREISLER DRUG INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477659779 NPI number — ADRIAN KREISLER DRUG INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADRIAN KREISLER DRUG 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:
1477659779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADRIAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-297-8833
Provider Business Mailing Address Fax Number:
816-297-2900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 E MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-297-8833
Provider Business Practice Location Address Fax Number:
816-297-2900
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENCE
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
STORE MANAGER
Authorized Official Telephone Number:
816-297-8833

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5977 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 005977 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 608271102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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