MEDICARE: STEVENSON FAMILY PHARMACY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies		MO
2	3336C0003X	Community/Retail Pharmacy	004687	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14405013	OTHER	MO	BCBSKC
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	:	1952349367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENSON FAMILY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	6201 KING HILL AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-2063
Country	:	US
Telephone Number	:	816-238-2424
Fax Number	:	816-238-6717

Provider Business Practice Location Address
First Line	:	6201 KING HILL AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-2063
Country	:	US
Telephone Number	:	816-238-2424
Fax Number	:	816-538-6717

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID STEVENSON
Credential	:	RPH
Telephone Number	:	816-238-2424

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/14/2013

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Directions to “STEVENSON FAMILY PHARMACY, INC. ” Practice Location

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