Healthcare Provider Details

I. General information

NPI: 1245318427
Provider Name (Legal Business Name): RED CROSS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW EAGLES PKWY
GRAIN VALLEY MO
64029-8521
US

IV. Provider business mailing address

52 E ARROW ST
MARSHALL MO
65340-2101
US

V. Phone/Fax

Practice location:
  • Phone: 816-847-2990
  • Fax: 816-847-2060
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 Number2003015457
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2003015457
License Number StateMO

VIII. Authorized Official

Name: MR. SCOTT BRENDEN HARTWIG
Title or Position: CO-PRESIDENT/CEO (OWNER)
Credential:
Phone: 660-886-5535