Healthcare Provider Details

I. General information

NPI: 1245318252
Provider Name (Legal Business Name): 50-PLUS LTC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 1/2 W LEXINGTON AVE
INDEPENDENCE MO
64050-3709
US

IV. Provider business mailing address

209 1/2 W LEXINGTON AVE
INDEPENDENCE MO
64050-3709
US

V. Phone/Fax

Practice location:
  • Phone: 816-833-5060
  • Fax: 816-461-0638
Mailing address:
  • Phone: 816-833-5060
  • Fax: 816-461-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number2000154001
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2000154001
License Number StateMO

VIII. Authorized Official

Name: JOHN F WALKER
Title or Position: COO
Credential: R.PH
Phone: 816-833-5060