Healthcare Provider Details

I. General information

NPI: 1518956093
Provider Name (Legal Business Name): PLEASANT HILL DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N STATE ROUTE 7
PLEASANT HILL MO
64080-9366
US

IV. Provider business mailing address

1905 N 7 HWY
PLEASANT HILL MO
64080-9366
US

V. Phone/Fax

Practice location:
  • Phone: 816-540-4000
  • Fax: 816-540-4341
Mailing address:
  • Phone: 816-540-4000
  • Fax: 816-540-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002009963
License Number StateMO

VIII. Authorized Official

Name: ALAN DEFEVER
Title or Position: PHARMACIST/PRESIDENT
Credential: RPH
Phone: 913-515-0462