=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508811944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALEAUMUA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 E MORGAN ST
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65340-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-886-6590
-----------------------------------------------------
Fax | 660-886-6090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8345 LENEXA DR SUITE 155
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66214-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-599-1101
-----------------------------------------------------
Fax | 913-599-0017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | RAYMOND D SALEAUMUA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-599-1101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 006451
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------