Provider Demographics
NPI:1891712659
Name:LIN KRIS PHARMACY INC
Entity Type:Organization
Organization Name:LIN KRIS PHARMACY INC
Other - Org Name:HOUSE SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:H
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-671-4600
Mailing Address - Street 1:4642 HOUSE SPRINGS CTR
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-1376
Mailing Address - Country:US
Mailing Address - Phone:636-671-4600
Mailing Address - Fax:636-671-3388
Practice Address - Street 1:4642 HOUSE SPRINGS CTR
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-1376
Practice Address - Country:US
Practice Address - Phone:636-671-4600
Practice Address - Fax:636-671-3388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIN KRIS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020058223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600748701Medicaid