Provider Demographics
NPI:1639284730
Name:FOUR B CORP
Entity Type:Organization
Organization Name:FOUR B CORP
Other - Org Name:PRICE CHOPPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-573-1294
Mailing Address - Street 1:5300 SPEAKER RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-1050
Mailing Address - Country:US
Mailing Address - Phone:913-573-1294
Mailing Address - Fax:913-551-8580
Practice Address - Street 1:2101 E SANTA FE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1606
Practice Address - Country:US
Practice Address - Phone:913-782-2323
Practice Address - Fax:913-764-2754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
KS2-08121333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439450AMedicaid
KS100439450BMedicaid
2025983OtherPK
KS100439450BMedicaid
KS100439450BMedicaid