Provider Demographics
NPI:1790953990
Name:FOUR B CORP
Entity Type:Organization
Organization Name:FOUR B CORP
Other - Org Name:PRICE CHOPPER PHARMACY #42
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-573-1294
Mailing Address - Street 1:5300 SPEAKER RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-1050
Mailing Address - Country:US
Mailing Address - Phone:913-573-1294
Mailing Address - Fax:913-551-8580
Practice Address - Street 1:16665 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5601
Practice Address - Country:US
Practice Address - Phone:913-829-5808
Practice Address - Fax:913-768-3802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KS2-101643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439440JMedicaid
KS100439440IMedicaid
KS1790953990OtherNPI
1719319OtherNCPDP PROVIDER IDENTIFICATION NUMBER