Provider Demographics
NPI:1366504805
Name:PRESCRIPTICARE LLC
Entity Type:Organization
Organization Name:PRESCRIPTICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-231-2330
Mailing Address - Street 1:3545 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-231-2330
Mailing Address - Fax:816-483-2301
Practice Address - Street 1:3545 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2501
Practice Address - Country:US
Practice Address - Phone:816-231-2330
Practice Address - Fax:816-483-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020015043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2631871OtherNCPDP