Organization
CROSSROADS PHARMACY INC
Active
Other names
CROSSROADS PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY BOMBARDIER PHARM. D. (PHARMACIST IN CHARGE)
(785) 527-2200
Entity
Organization
Contact information
Practice address
2311 M ST, BELLEVILLE, KS 66935-2555
(785) 527-2200
(785) 527-2338
Mailing address
PO BOX 305, BELLEVILLE, KS 66935-0305
(785) 527-2200
(785) 527-2338
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
210137
KS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100443620A
—
KS
01
—
1716844
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
05/06/2011
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