MEDICARE: PLEASANT HILL DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	2002009963	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2048807	OTHER	PK

General Provider Information

NPI Number	:	1518956093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT HILL DRUG STORE INC

Provider Business Mailing Address
First Line	:	1905 N 7 HWY
Second Line	:
City	:	PLEASANT HILL
State	:	MO
Zip	:	64080-9366
Country	:	US
Telephone Number	:	816-540-4000
Fax Number	:	816-540-4341

Provider Business Practice Location Address
First Line	:	1905 N STATE ROUTE 7
Second Line	:
City	:	PLEASANT HILL
State	:	MO
Zip	:	64080-9366
Country	:	US
Telephone Number	:	816-540-4000
Fax Number	:	816-540-4341

Authorized Official
Title or Position	:	PHARMACIST/PRESIDENT
Name	:	ALAN DEFEVER
Credential	:	RPH
Telephone Number	:	913-515-0462

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	04/12/2016

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Directions to “PLEASANT HILL DRUG STORE INC ” Practice Location

Language	Start Address	Practice Location

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