Healthcare Provider Details

I. General information

NPI: 1891712659
Provider Name (Legal Business Name): LIN KRIS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 HOUSE SPRINGS CTR
HOUSE SPRINGS MO
63051-1376
US

IV. Provider business mailing address

4642 HOUSE SPRINGS CTR
HOUSE SPRINGS MO
63051-1376
US

V. Phone/Fax

Practice location:
  • Phone: 636-671-4600
  • Fax: 636-671-3388
Mailing address:
  • Phone: 636-671-4600
  • Fax: 636-671-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002005822
License Number StateMO

VIII. Authorized Official

Name: MR. ROY H EBERHART II
Title or Position: PRESIDENT/OWNER
Credential: R.PH
Phone: 636-671-4600