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General NPI Number Information
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NPI Number | 1184614182
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Entity Type | Organization
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Legal Business Name | ROSTIE ENTERPRISES, LLC
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 547 N SCOTT AVE
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City | BELTON
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State | MO
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Zip | 64012-1762
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Country | US
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Telephone | 816-331-6040
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Fax | 816-331-7248
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Provider Business Mailing Address
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Address Line | 547 N SCOTT AVE
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City | BELTON
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State | MO
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Zip | 64012-1762
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Country | US
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Telephone | 816-331-6040
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Fax | 816-331-7248
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MRS. MARY LYNN ROSTIE
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Credential | R.PH.
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Telephone | 816-331-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2001019642
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License Number State | MO
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