Healthcare Provider Details

I. General information

NPI: 1952415929
Provider Name (Legal Business Name): BDS PHARMACEUTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SW EAGLES PKWY
GRAIN VALLEY MO
64029-8508
US

IV. Provider business mailing address

1400 SW EAGLES PKWY PO BOX 329
GRAIN VALLEY MO
64029-8508
US

V. Phone/Fax

Practice location:
  • Phone: 816-847-9200
  • Fax: 816-847-9210
Mailing address:
  • Phone: 816-847-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2002030200
License Number StateMO

VIII. Authorized Official

Name: BRYON CONRAD
Title or Position: PIC
Credential: RPH
Phone: 816-847-9200