Provider Demographics
NPI:1942281209
Name:JOPLIN PHARMACY ASSOCIATES
Entity Type:Organization
Organization Name:JOPLIN PHARMACY ASSOCIATES
Other - Org Name:SENIOR CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-310-8627
Mailing Address - Street 1:3220 WISCONSIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-626-5797
Practice Address - Street 1:3220 WISCONSIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4047
Practice Address - Country:US
Practice Address - Phone:417-626-8180
Practice Address - Fax:417-626-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
ARPN01475183500000X
MO2005033292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100444740AMedicaid
MO604752907Medicaid
1999137960OtherSTATE LICENSE
2632873OtherNCPDP
AR13845407Medicaid