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General NPI Number Information
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NPI Number | 1285059089
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Entity Type | Organization
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Legal Business Name | KPBN APOTHECARY LLC
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 5540 N FARMER BRANCH RD
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City | OZARK
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State | MO
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Zip | 65721-5315
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Country | US
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Telephone | 417-485-8555
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Fax | 417-485-8559
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Provider Business Mailing Address
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Address Line | 5540 N FARMER BRANCH RD
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City | OZARK
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State | MO
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Zip | 65721-5315
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Country | US
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Telephone | 417-485-8555
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Fax | 417-485-8559
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. NATHANIEL PAUL ALDRICH
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Credential | PHARMD
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Telephone | 417-485-8555
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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 | 2014004590
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2014004590
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2014004590
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License Number State | MO
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