Healthcare Provider Details

I. General information

NPI: 1619015609
Provider Name (Legal Business Name): RED CROSS PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
BELTON MO
64012-2511
US

IV. Provider business mailing address

PO BOX 917
MARSHALL MO
65340-0917
US

V. Phone/Fax

Practice location:
  • Phone: 816-892-1200
  • Fax: 816-331-2400
Mailing address:
  • Phone: 660-886-5535
  • Fax: 660-886-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number000792
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT B HARTWIG
Title or Position: CO-PRESIDENT/CEO
Credential:
Phone: 660-886-5535