Provider Demographics
NPI:1659398410
Name:LIN-KRIS PHARMACY INC
Entity Type:Organization
Organization Name:LIN-KRIS PHARMACY INC
Other - Org Name:CEDAR HILL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-274-3111
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-0034
Mailing Address - Country:US
Mailing Address - Phone:636-274-3111
Mailing Address - Fax:636-274-7083
Practice Address - Street 1:7032 STATE ROUTE BB
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016
Practice Address - Country:US
Practice Address - Phone:636-274-3111
Practice Address - Fax:636-274-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
MO20020058243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048788OtherPK
MO600248009Medicaid