Provider Demographics
NPI:1083098263
Name:TOP NOTCH PHARMACIES LLC
Entity Type:Organization
Organization Name:TOP NOTCH PHARMACIES LLC
Other - Org Name:PRATER'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-592-7381
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:SARCOXIE
Mailing Address - State:MO
Mailing Address - Zip Code:64862-0625
Mailing Address - Country:US
Mailing Address - Phone:417-548-7184
Mailing Address - Fax:417-548-7404
Practice Address - Street 1:1412 HIGH ST
Practice Address - Street 2:
Practice Address - City:SARCOXIE
Practice Address - State:MO
Practice Address - Zip Code:64862
Practice Address - Country:US
Practice Address - Phone:417-548-7184
Practice Address - Fax:417-548-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20150299473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO603755307Medicaid
2153702OtherPK