Organization
IVNA PHARMACY SERVICES LLC
Active
Other names
Stadium Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VIKRANTH K ANNEBOINA (OWNER)
(636) 544-4525
Entity
Organization
Contact information
Practice address
1741 NE DOUGLAS ST STE 102, LEES SUMMIT, MO 64086-4704
(636) 544-4525
Mailing address
1741 NE DOUGLAS ST STE 102, LEES SUMMIT, MO 64086-4704
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2017040100
MO
Other
Enumeration date
11/13/2017
Last updated
06/16/2018
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