Healthcare Provider Details

I. General information

NPI: 1265419402
Provider Name (Legal Business Name): PECULIAR PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N MAIN ST
PECULIAR MO
64078-2522
US

IV. Provider business mailing address

PO BOX 458
PECULIAR MO
64078-0458
US

V. Phone/Fax

Practice location:
  • Phone: 816-779-6100
  • Fax: 816-779-6111
Mailing address:
  • Phone: 816-779-6100
  • Fax: 816-779-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2004028606
License Number StateMO

VIII. Authorized Official

Name: MS. HEATHER ANN NEWELL
Title or Position: OWNER
Credential: CPHT
Phone: 816-779-6100