Provider Demographics
NPI:1861506834
Name:LAMARTIS INC
Entity Type:Organization
Organization Name:LAMARTIS INC
Other - Org Name:THE MED STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-681-0999
Mailing Address - Street 1:107 SE 1ST LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-9220
Mailing Address - Country:US
Mailing Address - Phone:417-681-0999
Mailing Address - Fax:417-681-0438
Practice Address - Street 1:54B SE 1ST LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-9226
Practice Address - Country:US
Practice Address - Phone:417-681-0999
Practice Address - Fax:417-681-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO20030192923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606068203Medicaid
MO626068209Medicaid
2048950OtherPK
2048950OtherPK