Provider Demographics
NPI:1740368604
Name:RED CROSS PHARMACY, INC.
Entity type:Organization
Organization Name:RED CROSS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT/CEO (OWNER)
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRENDEN
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-5535
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-0917
Mailing Address - Country:US
Mailing Address - Phone:660-886-5533
Mailing Address - Fax:660-886-6320
Practice Address - Street 1:161 S BENTON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1836
Practice Address - Country:US
Practice Address - Phone:660-886-5533
Practice Address - Fax:660-886-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000132332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600305205Medicaid
MO600305205Medicaid