Provider Demographics
NPI:1952349367
Name:STEVENSON FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:STEVENSON FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-238-2424
Mailing Address - Street 1:6201 KING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64504-2063
Mailing Address - Country:US
Mailing Address - Phone:816-238-2424
Mailing Address - Fax:816-238-6717
Practice Address - Street 1:6201 KING HILL AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64504-2063
Practice Address - Country:US
Practice Address - Phone:816-238-2424
Practice Address - Fax:816-538-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
MO0046873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14405013OtherBCBSKC
MO600200604Medicaid
MO620200600Medicaid
MO0755720001Medicare ID - Type Unspecified