Provider Demographics
NPI:1124193701
Name:QUEEN-MORRIS VENTURES L L C
Entity Type:Organization
Organization Name:QUEEN-MORRIS VENTURES L L C
Other - Org Name:QUEEN'S PRICE CHOPPER #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-378-6938
Mailing Address - Street 1:8686 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3648
Mailing Address - Country:US
Mailing Address - Phone:913-642-4140
Mailing Address - Fax:913-648-0100
Practice Address - Street 1:8686 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3648
Practice Address - Country:US
Practice Address - Phone:913-642-4140
Practice Address - Fax:913-648-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-089553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200402260AMedicaid
KS100440080C DMEMedicaid
2026150OtherPK