Provider Demographics
NPI:1780789305
Name:KREISLER DRUG CO. INC.
Entity type:Organization
Organization Name:KREISLER DRUG CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-885-5551
Mailing Address - Street 1:117 W. FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735
Mailing Address - Country:US
Mailing Address - Phone:660-885-5551
Mailing Address - Fax:660-885-6940
Practice Address - Street 1:117 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2007
Practice Address - Country:US
Practice Address - Phone:660-885-5551
Practice Address - Fax:660-885-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO600129803332B00000X
MO26833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600129803Medicaid
MO600129803Medicaid