Provider Demographics
NPI:1659367399
Name:KESSLER PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:KESSLER PHARMACY SERVICES LLC
Other - Org Name:NORTHLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-931-0100
Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:STE 106
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-931-0100
Mailing Address - Fax:816-931-3677
Practice Address - Street 1:9411 N OAK TRFY
Practice Address - Street 2:STE 120
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2233
Practice Address - Country:US
Practice Address - Phone:816-436-2400
Practice Address - Fax:816-468-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090123943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048985OtherPK
MO600122501Medicaid