MEDICARE: GENERAL STORE NO TWO 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	006016	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2047521	OTHER		PK

General Provider Information

NPI Number	:	1962572537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL STORE NO TWO INC

Provider Business Mailing Address
First Line	:	4001 MILL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3008
Country	:	US
Telephone Number	:	816-931-1505
Fax Number	:	816-931-4236

Provider Business Practice Location Address
First Line	:	4001 MILL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3008
Country	:	US
Telephone Number	:	816-931-1505
Fax Number	:	816-931-0020

Authorized Official
Title or Position	:	OWNER
Name	:	JIM MARSH
Credential	:
Telephone Number	:	816-931-1639

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	01/29/2014

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Directions to “GENERAL STORE NO TWO INC ” Practice Location

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