Provider Demographics
NPI:1487641619
Name:ROCKHILL PHARMACY, LLC
Entity Type:Organization
Organization Name:ROCKHILL PHARMACY, LLC
Other - Org Name:ROCKHILL LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-799-0123
Mailing Address - Street 1:PO BOX 5930
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64171-0930
Mailing Address - Country:US
Mailing Address - Phone:816-799-0123
Mailing Address - Fax:816-931-0282
Practice Address - Street 1:4240 SOUTHWEST TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-6910
Practice Address - Country:US
Practice Address - Phone:816-799-0123
Practice Address - Fax:816-931-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174992333600000X
MO20001749223336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200420590AMedicaid
MO605189109Medicaid
MO625189105Medicaid
KS200420590BMedicaid
2633661OtherNABP PROVIDER NUMBER
MO605189109Medicaid