=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164656385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIN-KRIS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2009
-----------------------------------------------------
Last Update Date | 05/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2060 ROCK RD
-----------------------------------------------------
City | DE SOTO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63020-1052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-337-1761
-----------------------------------------------------
Fax | 636-586-0007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2060 ROCK RD
-----------------------------------------------------
City | DE SOTO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63020-1052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-337-1761
-----------------------------------------------------
Fax | 636-586-0007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROY H EBERHART II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-337-1761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------