Healthcare Provider Details

I. General information

NPI: 1043928104
Provider Name (Legal Business Name): SHOW ME STATE INFUSION PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NW BUSINESS PARK LN
RIVERSIDE MO
64150-9572
US

IV. Provider business mailing address

420 NW BUSINESS PARK LN
RIVERSIDE MO
64150-9572
US

V. Phone/Fax

Practice location:
  • Phone: 816-552-5200
  • Fax: 816-552-5201
Mailing address:
  • Phone: 816-552-5200
  • Fax: 816-552-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROSS VOGEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 816-552-5200