Provider Demographics
NPI:1811050669
Name:BLOODHART DRUG LLC
Entity type:Organization
Organization Name:BLOODHART DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-777-0609
Mailing Address - Street 1:PO BOX 6680
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-6680
Mailing Address - Country:US
Mailing Address - Phone:816-777-0609
Mailing Address - Fax:816-777-0615
Practice Address - Street 1:621 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2419
Practice Address - Country:US
Practice Address - Phone:620-544-4369
Practice Address - Fax:620-544-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS004300246227F01183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200118220-AMedicaid
KS200452510-BMedicaid
KS200452510-AMedicaid
KS203043087OtherLANSING PHARMACY
KS118383OtherBLUE CROSS BLUE SHIELD
CO203303814OtherKOHLER PROFESSIONAL PHARM
CO203303814OtherKOHLER PROFESSIONAL PHARM
KS200452510-AMedicaid