Provider Demographics
NPI:1891800991
Name:FOUR B CORP
Entity Type:Organization
Organization Name:FOUR B CORP
Other - Org Name:PRICE CHOPPER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPPORT
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 1:6475 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-1545
Practice Address - Country:US
Practice Address - Phone:816-453-0503
Practice Address - Fax:816-453-0543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MO2000148963333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO604889006Medicaid
MO624889002Medicaid
2048349OtherPK
0450260013Medicare NSC
0450260013Medicare NSC