| NPI | 1477659779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE A PENCE Store Manager 816-297-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MO 5977) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: MO 005977) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-07-09 |