Provider Demographics
NPI:1265506786
Name:LAMP FOOD STORES INC
Entity Type:Organization
Organization Name:LAMP FOOD STORES INC
Other - Org Name:SUN FRESH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-252-0138
Mailing Address - Street 1:2301 S STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-3666
Mailing Address - Country:US
Mailing Address - Phone:816-461-1287
Mailing Address - Fax:816-252-5860
Practice Address - Street 1:2301 S STERLING AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-3666
Practice Address - Country:US
Practice Address - Phone:816-461-1287
Practice Address - Fax:816-252-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0056493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047142OtherPK
MO602303604Medicaid
1167080006Medicare NSC