Provider Demographics
NPI:1790835874
Name:KULER DRUGS LLC
Entity Type:Organization
Organization Name:KULER DRUGS LLC
Other - Org Name:MED DEPOT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTTENKULER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-665-7239
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1443
Mailing Address - Country:US
Mailing Address - Phone:660-665-7239
Mailing Address - Fax:660-665-6474
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-665-7239
Practice Address - Fax:660-665-6474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KULER DRUGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0047523336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601504608Medicaid
MO601504608Medicaid