Provider Demographics
NPI:1659443448
Name:BRITIM INC
Entity Type:Organization
Organization Name:BRITIM INC
Other - Org Name:KRIBBS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY PLAN COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-263-8020
Mailing Address - Street 1:319 W REED ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1558
Mailing Address - Country:US
Mailing Address - Phone:660-263-8020
Mailing Address - Fax:660-263-7054
Practice Address - Street 1:319 W REED ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1558
Practice Address - Country:US
Practice Address - Phone:660-263-8020
Practice Address - Fax:660-263-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0065843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2619611OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO601587108Medicaid
2619611OtherNCPDP PROVIDER IDENTIFICATION NUMBER