Provider Demographics
NPI:1366465254
Name:MCCORMICKS PHARMACY
Entity Type:Organization
Organization Name:MCCORMICKS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-531-3434
Mailing Address - Street 1:4320 WORNALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5952
Mailing Address - Country:US
Mailing Address - Phone:816-531-3434
Mailing Address - Fax:816-531-3441
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5952
Practice Address - Country:US
Practice Address - Phone:816-531-3434
Practice Address - Fax:816-531-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060199853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5755340001Medicare NSC