Provider Demographics
NPI:1265813281
Name:PRESCRIPTION MANAGEMENT ASSOCIATES
Entity type:Organization
Organization Name:PRESCRIPTION MANAGEMENT ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-916-6114
Mailing Address - Street 1:4300 BRENNER DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-1163
Mailing Address - Country:US
Mailing Address - Phone:816-249-2780
Mailing Address - Fax:816-875-3304
Practice Address - Street 1:8301 STATE LINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2025
Practice Address - Country:US
Practice Address - Phone:816-249-2780
Practice Address - Fax:816-875-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140291233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20110255AMedicaid