Queen City Pharmacies, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2017031169 Issued in MO

Legal business name

QUEEN CITY PHARMACIES, LLC

Practice address

1474 N Boonville Ave
Springfield, MO 65802-1806

Phone

(417) 869-1866

Fax

(417) 869-6601

NPI assigned

Nov 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rebekah Ann Rose

Title

Operations Manager

Phone

(417) 881-8841

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Medicenter Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Queen City Pharmacies, LLC

  • Community/Retail Pharmacy
  • Springfield, MO
  • NPI 1770655391

  O20170914002179

  Same enrollment

Tax ID family

Boonville Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Queen City Pharmacies, LLC

  • Long Term Care Pharmacy
  • Springfield, MO
  • NPI 1194506329
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Todd Codemo, PHARMD

  • Pharmacist
  • Springfield, MO
  • NPI 1851797930
  NPD (past)
• Jeremy Popek, PHARMD,R.PH.

  • Pharmacist
  • Springfield, MO
  • NPI 1194121202
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1013089804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1474 N BOONVILLE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658021806",
            "telephone_number": "417-869-1866",
            "fax_number": "417-869-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1474 N BOONVILLE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658021806",
            "telephone_number": "417-869-1866",
            "fax_number": "417-869-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN CITY PHARMACIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "417-881-8841"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "006537",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2017031169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2603810",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600051320",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicenter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Qualls, PLPC
• Queen City Anesthesia Group LLC
• Queen City Anesthesia Group, LLC
• Queen City Anesthesia Group, LLC
• Queen City Anesthesia Group, LLC
• Queen City Pharmacies, LLC
• Queen City Pharmacies, LLC
• Megan Rene Quella, NP
• Sara Elizabeth Quick, MS, LPC
• Quiet Strength Counseling, LLC

• Community/Retail Pharmacy in Springfield, MO
• Providers in Springfield, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.