=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528578267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUFFETT HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2017
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 JOHNNY WALKER LN STE B
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64085-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-776-6926
-----------------------------------------------------
Fax | 816-776-3144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 JOHNNY WALKER LN STE B
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64085-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-776-6926
-----------------------------------------------------
Fax | 816-776-3144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN ELIZABETH DUFFETT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 816-776-6926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 2014000270
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------