Organization
50-PLUS LTC PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN F WALKER R.PH (COO)
(816) 833-5060
Entity
Organization
Contact information
Practice address
209 1/2 W LEXINGTON AVE, INDEPENDENCE, MO 64050-3709
(816) 833-5060
(816) 461-0638
Mailing address
209 1/2 W LEXINGTON AVE, INDEPENDENCE, MO 64050-3709
(816) 833-5060
(816) 461-0638
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
2000154001
MO
3336L0003X
Long Term Care Pharmacy
Primary
2000154001
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604898809
—
MO
Enumeration date
11/01/2006
Last updated
06/22/2012
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