MEDICARE: PRESCRIPTICARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	2002001504	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2631871	OTHER		NCPDP

General Provider Information

NPI Number	:	1366504805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTICARE LLC

Provider Business Mailing Address
First Line	:	3545 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2501
Country	:	US
Telephone Number	:	816-231-2330
Fax Number	:	816-483-2301

Provider Business Practice Location Address
First Line	:	3545 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2501
Country	:	US
Telephone Number	:	816-231-2330
Fax Number	:	816-483-2301

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. THOMAS G SQUIRES
Credential	:	R.PH.
Telephone Number	:	816-231-2330

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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Directions to “PRESCRIPTICARE LLC ” Practice Location

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