Provider Demographics
NPI:1114357761
Name:DUFFETT HOLDINGS LLC
Entity Type:Organization
Organization Name:DUFFETT HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-776-6926
Mailing Address - Street 1:508 JOHNNY WALKER LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085
Mailing Address - Country:US
Mailing Address - Phone:816-776-6926
Mailing Address - Fax:816-776-3144
Practice Address - Street 1:508 JOHNNY WALKER LANE
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085
Practice Address - Country:US
Practice Address - Phone:816-776-6926
Practice Address - Fax:816-776-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
MO20140002703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143674OtherPK
MO601710403Medicaid
2143674OtherPK