Organization
KCJSE INC
Active
Other names
THE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
JS ERICKSON PHARMACY (CEO)
(816) 632-7211
Entity
Organization
Contact information
Practice address
610 N WALNUT ST, CAMERON, MO 64429-1831
(816) 632-7211
(816) 632-3645
Mailing address
610 N WALNUT ST, CAMERON, MO 64429-1831
(816) 632-7211
(816) 632-3645
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004493
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049743
PK
—
05
—
600280101
—
MO
05
—
620028100
—
MO
Enumeration date
09/12/2005
Last updated
04/29/2020
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