Provider Demographics
NPI:1700991809
Name:FOUR B CORP
Entity Type:Organization
Organization Name:FOUR B CORP
Other - Org Name:PRICE CHOPPER PHARMACY #11
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-573-1294
Mailing Address - Street 1:5300 SPEAKER RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-1050
Mailing Address - Country:US
Mailing Address - Phone:913-573-1294
Mailing Address - Fax:913-551-8580
Practice Address - Street 1:207 NE ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4586
Practice Address - Country:US
Practice Address - Phone:816-452-8845
Practice Address - Fax:816-452-6794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20010256343336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048728OtherPK
MO605679604Medicaid
MO625679600Medicaid
0450260014Medicare NSC