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General NPI Number Information
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NPI Number | 1811050669
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Entity Type | Organization
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Legal Business Name | BLOODHART DRUG LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 621 S MAIN ST
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City | HUGOTON
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State | KS
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Zip | 67951-2419
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Country | US
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Telephone | 620-544-4369
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Fax | 620-544-7045
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Provider Business Mailing Address
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Address Line | PO BOX 6680
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City | LEES SUMMIT
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State | MO
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Zip | 64064-6680
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Country | US
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Telephone | 816-777-0609
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Fax | 816-777-0615
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ROBERT WINTERS
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Credential |
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Telephone | 816-777-0609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 004300246227F01
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License Number State | KS
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