Healthcare Provider Details

I. General information

NPI: 1356456453
Provider Name (Legal Business Name): FOUR B CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 WORNALL RD
KANSAS CITY MO
64114-5812
US

IV. Provider business mailing address

5830 WOODSON ST
MISSION KS
66202-2746
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-5000
  • Fax: 816-361-2642
Mailing address:
  • Phone: 913-573-1294
  • Fax: 913-551-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5644
License Number StateMO

VIII. Authorized Official

Name: JANICE HUMPHREYS
Title or Position: THIRD PARTY ADMIN
Credential:
Phone: 913-573-1294