Provider Demographics
NPI:1588754725
Name:50-PLUS PHARMACY INC.
Entity type:Organization
Organization Name:50-PLUS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-833-5060
Mailing Address - Street 1:211 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3709
Mailing Address - Country:US
Mailing Address - Phone:816-833-5060
Mailing Address - Fax:816-461-0638
Practice Address - Street 1:211 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3709
Practice Address - Country:US
Practice Address - Phone:816-833-5060
Practice Address - Fax:816-461-0638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:50 PLUS PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0054003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600448302Medicaid
MO620448308Medicaid
MO620448308Medicaid