1942281209 NPI number — JOPLIN PHARMACY ASSOCIATES

Table of content: (NPI 1942281209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942281209 NPI number — JOPLIN PHARMACY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOPLIN PHARMACY ASSOCIATES
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:
1942281209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-4047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
888-626-5797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-626-8180
Provider Business Practice Location Address Fax Number:
417-626-8176
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CONNOR
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
205-310-8627

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100444740A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604752907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1999137960 . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2632873 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13845407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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