Healthcare Provider Details

I. General information

NPI: 1538221767
Provider Name (Legal Business Name): KULER DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
JEFFERSON ST MO
63501-1443
US

IV. Provider business mailing address

800 W JEFFERSON ST
JEFFERSON ST MO
63501-1443
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-7239
  • Fax:
Mailing address:
  • Phone: 660-665-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2005011251
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. STEVE KUTTENKULER
Title or Position: OWNER
Credential: RPH
Phone: 660-665-7239