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General NPI Number Information
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NPI Number | 1407900434
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Entity Type | Organization
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Legal Business Name | BLKC, INC. (D/B/A PREMIER COMPOUNDING PHARMACY)
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 1427 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2459
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Country | US
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Telephone | 816-279-6700
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Fax | 816-279-5603
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Provider Business Mailing Address
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Address Line | 1427 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2459
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Country | US
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Telephone | 816-279-6700
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Fax | 816-279-5603
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | WILLIAM A LIPIRA
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Credential |
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Telephone | 816-279-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 041133
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 006462
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2013022132
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License Number State | MO
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