Provider Demographics
NPI:1285059089
Name:KPBN APOTHECARY LLC
Entity type:Organization
Organization Name:KPBN APOTHECARY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-485-8555
Mailing Address - Street 1:5540 N FARMER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5315
Mailing Address - Country:US
Mailing Address - Phone:417-485-8555
Mailing Address - Fax:417-485-8559
Practice Address - Street 1:5540 N FARMER BRANCH RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-5315
Practice Address - Country:US
Practice Address - Phone:417-485-8555
Practice Address - Fax:417-485-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004590333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy