Provider Demographics
NPI:1669814182
Name:PARKLAND PHARMACY DEVELOPMENT LLC
Entity Type:Organization
Organization Name:PARKLAND PHARMACY DEVELOPMENT LLC
Other - Org Name:PARKLAND HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF LLC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:UMFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-747-8333
Mailing Address - Street 1:1025 E HIGHWAY 72 BYP
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7326
Mailing Address - Country:US
Mailing Address - Phone:573-783-6000
Mailing Address - Fax:573-783-6008
Practice Address - Street 1:1500 N HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-9147
Practice Address - Country:US
Practice Address - Phone:573-546-6000
Practice Address - Fax:573-546-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO20130246673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1669814182Medicaid
2140129OtherPK
MO1669814182Medicaid