Provider Demographics
NPI:1922090158
Name:RED CROSS PHARMACY, INC
Entity Type:Organization
Organization Name:RED CROSS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-5535
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-0917
Mailing Address - Country:US
Mailing Address - Phone:660-886-5535
Mailing Address - Fax:660-886-6320
Practice Address - Street 1:103 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2461
Practice Address - Country:US
Practice Address - Phone:816-380-3321
Practice Address - Fax:816-887-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025199332B00000X
MO004160333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600280705Medicaid
MO1151730014Medicare NSC
MO9009519Medicare PIN