Provider Demographics
NPI:1861511065
Name:KREISLER DRUG #3
Entity Type:Organization
Organization Name:KREISLER DRUG #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-885-6589
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-0528
Mailing Address - Country:US
Mailing Address - Phone:660-885-2227
Mailing Address - Fax:660-885-6589
Practice Address - Street 1:1810 E OHIO ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2429
Practice Address - Country:US
Practice Address - Phone:660-885-2227
Practice Address - Fax:660-885-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPS004203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies