Provider Demographics
NPI:1003971433
Name:PHARM JOPLIN ACQUISITION, LLC
Entity type:Organization
Organization Name:PHARM JOPLIN ACQUISITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-840-7514
Mailing Address - Street 1:2131 E 32ND ST STE 3
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3074
Mailing Address - Country:US
Mailing Address - Phone:417-781-2332
Mailing Address - Fax:417-659-8344
Practice Address - Street 1:2131 E 32ND ST STE 3
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3074
Practice Address - Country:US
Practice Address - Phone:417-781-2332
Practice Address - Fax:417-659-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20150000563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150667OtherPK
MO602031403Medicaid
KS20108450AMedicaid
OK200504810AMedicaid