Provider Demographics
NPI:1376919043
Name:DUFFETT HOLDINGS 2, LLC
Entity Type:Organization
Organization Name:DUFFETT HOLDINGS 2, LLC
Other - Org Name:MINUTEMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:816-517-0395
Mailing Address - Street 1:545 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1437
Mailing Address - Country:US
Mailing Address - Phone:660-259-3455
Mailing Address - Fax:
Practice Address - Street 1:545 S BUSINESS HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1437
Practice Address - Country:US
Practice Address - Phone:660-259-3455
Practice Address - Fax:660-259-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150293193336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600024994Medicaid
2153530OtherPK