Healthcare Provider Details

I. General information

NPI: 1184614182
Provider Name (Legal Business Name): ROSTIE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 N SCOTT AVE
BELTON MO
64012-1762
US

IV. Provider business mailing address

547 N SCOTT AVE
BELTON MO
64012-1762
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-6040
  • Fax: 816-331-7248
Mailing address:
  • Phone: 816-331-6040
  • Fax: 816-331-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2001019642
License Number StateMO

VIII. Authorized Official

Name: MRS. MARY LYNN ROSTIE
Title or Position: MEMBER/MANAGER
Credential: R.PH.
Phone: 816-331-6040