Provider Demographics
NPI:1245318252
Name:50-PLUS LTC PHARMACY
Entity type:Organization
Organization Name:50-PLUS LTC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-833-5060
Mailing Address - Street 1:209 1/2 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3709
Mailing Address - Country:US
Mailing Address - Phone:816-833-5060
Mailing Address - Fax:816-461-0638
Practice Address - Street 1:209 1/2 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3709
Practice Address - Country:US
Practice Address - Phone:816-833-5060
Practice Address - Fax:816-461-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154001332BN1400X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO604898809Medicaid
MO0821730002Medicare NSC