1487641619 NPI number — ROCKHILL PHARMACY, LLC

Table of content: (NPI 1487641619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487641619 NPI number — ROCKHILL PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKHILL PHARMACY, 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:
Provider Other Organization Name Type Code:
6
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:
1487641619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5930
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64171-0930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-799-0123
Provider Business Mailing Address Fax Number:
816-931-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4240 SOUTHWEST TRFY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-799-0123
Provider Business Practice Location Address Fax Number:
816-931-0282
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
STACY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGER/PHARMACIST IN CHARGE
Authorized Official Telephone Number:
816-799-0123

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  2000174922 , 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: 2000174992 , 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: 200420590A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 605189109 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625189105 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200420590B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2633661 . This is a "NABP PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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