Provider Demographics
NPI:1083629612
Name:CENTER PHARMACY INC
Entity Type:Organization
Organization Name:CENTER PHARMACY INC
Other - Org Name:CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-453-0200
Mailing Address - Street 1:4357 N CHOUTEAU TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-1743
Mailing Address - Country:US
Mailing Address - Phone:816-453-0200
Mailing Address - Fax:816-452-6778
Practice Address - Street 1:4357 NE CHOUTEAU TFWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117
Practice Address - Country:US
Practice Address - Phone:816-453-0200
Practice Address - Fax:816-452-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO035703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600097604Medicaid
2608036OtherNCPDP PROVIDER IDENTIFICATION NUMBER