Healthcare Provider Details

I. General information

NPI: 1841302791
Provider Name (Legal Business Name): CROSSROADS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 M ST
BELLEVILLE KS
66935-2555
US

IV. Provider business mailing address

PO BOX 305
BELLEVILLE KS
66935-0305
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-2200
  • Fax: 785-527-2338
Mailing address:
  • Phone: 785-527-2200
  • Fax: 785-527-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number210137
License Number StateKS

VIII. Authorized Official

Name: ANTHONY BOMBARDIER
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM. D.
Phone: 785-527-2200