Provider Demographics
NPI:1306891734
Name:RED CROSS PHARMACY, INC
Entity type:Organization
Organization Name:RED CROSS PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT/CEO (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-5535
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-0917
Mailing Address - Country:US
Mailing Address - Phone:660-886-5535
Mailing Address - Fax:660-886-6320
Practice Address - Street 1:1712 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1345
Practice Address - Country:US
Practice Address - Phone:660-584-2110
Practice Address - Fax:660-584-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007033676332B00000X
MO20070336753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO605194307Medicaid
MO605194307Medicaid