Healthcare Provider Details

I. General information

NPI: 1578679056
Provider Name (Legal Business Name): KB EVANS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E US HIGHWAY 54
EL DORADO SPRINGS MO
64744-1925
US

IV. Provider business mailing address

209 E US HIGHWAY 54
EL DORADO SPRINGS MO
64744-1925
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-3313
  • Fax: 417-876-3813
Mailing address:
  • Phone: 417-876-3313
  • Fax: 417-876-3813

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 Number2010042680
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2010042680
License Number StateMO

VIII. Authorized Official

Name: KEVIN MCCULLOUGH
Title or Position: CHIEF PHARMACIST/OWNER
Credential: RPH
Phone: 417-876-3313