Provider Demographics
NPI:1265419402
Name:PECULIAR PHARMACY LLC
Entity type:Organization
Organization Name:PECULIAR PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:816-779-6100
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0458
Mailing Address - Country:US
Mailing Address - Phone:816-779-6100
Mailing Address - Fax:816-779-6111
Practice Address - Street 1:219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-2522
Practice Address - Country:US
Practice Address - Phone:816-779-6100
Practice Address - Fax:816-779-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028606333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy