Provider Demographics
NPI:1568534352
Name:MSLS LLC
Entity Type:Organization
Organization Name:MSLS LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-524-8444
Mailing Address - Street 1:210 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2750
Mailing Address - Country:US
Mailing Address - Phone:816-524-8444
Mailing Address - Fax:816-246-5493
Practice Address - Street 1:210 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2750
Practice Address - Country:US
Practice Address - Phone:816-524-8444
Practice Address - Fax:816-246-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028359333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2621274OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MO602046406Medicaid
MO602046406Medicaid