MEDICARE: FOUR B CORP

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	333600000X	Pharmacy	9650	KS
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1717593	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801901905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR B CORP

Provider Business Mailing Address
First Line	:	6450 SPRINT PKWY
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66251-6105
Country	:	US
Telephone Number	:	913-315-8646
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 SPRINT PKWY
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66251-6105
Country	:	US
Telephone Number	:	913-315-8646
Fax Number	:	913-315-0653

Authorized Official
Title or Position	:	3RD PARTY ADMIN
Name	:	LISA MARTIN
Credential	:
Telephone Number	:	913-573-1294

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/10/2008

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Directions to “FOUR B CORP ” Practice Location

Language	Start Address	Practice Location

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