Healthcare Provider Details

I. General information

NPI: 1114357761
Provider Name (Legal Business Name): DUFFETT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 JOHNNY WALKER LANE SUITE B
RICHMOND MO
64085
US

IV. Provider business mailing address

508 JOHNNY WALKER LN STE B
RICHMOND MO
64085-1804
US

V. Phone/Fax

Practice location:
  • Phone: 816-776-6926
  • Fax: 816-776-3144
Mailing address:
  • Phone: 816-776-6926
  • Fax: 816-776-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2014000270
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DUFFETT
Title or Position: RPH
Credential:
Phone: 816-776-6926