Provider Demographics
NPI:1972924439
Name:RED CROSS PHARMACY, LLC
Entity type:Organization
Organization Name:RED CROSS PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
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 1:1000 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1244
Practice Address - Country:US
Practice Address - Phone:816-743-7320
Practice Address - Fax:816-659-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003021332BN1400X, 3336L0003X, 3336L0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6000011896Medicaid
KS30003897370001Medicaid