Organization Active NPI

Parkland Apothecary LLC

Doing business as Parkland Pharmacy

  • Community/Retail Pharmacy
  • Desloge, MO
National Provider Identifier
1114917903
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2005028538 Issued in MO
Legal business name
PARKLAND APOTHECARY LLC
Doing business as
Parkland Pharmacy
Practice address
1131 N Desloge Dr
Desloge, MO 63601-2936
Phone
(573) 431-6677
Fax
(573) 431-3833
NPI assigned
Oct 24, 2005
Last updated
Jan 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Authorized official

Name
Lisa Umfleet, RPHNPI 1528168689
Title
President
Phone
(573) 431-6677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 2005028538 MO Primary
Specialty Pharmacy 3336S0011X
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1131 N Desloge Dr
Desloge, MO 63601-2936

Mailing address

1131 N Desloge Dr
Desloge, MO 63601-2936
Phone (573) 431-6677

Other identifiers 2

IdentifierTypeStateIssuer
2049127OtherPK
606222008MedicaidMO

Other names 1

  • Parkland Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930092312 MO DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 7214138015 Practice locations: Desloge, MO
O20121117000020 MO Part B Supplier - Mass Immunization (Roster Biller Only) 7214138015 Practice locations: Desloge, MO
O20130816000775 MO Part B Supplier - Pharmacy 7214138015 Practice locations: Desloge, MO

National Provider Directory

National Provider Directory

Locations

1131 N Desloge Dr
Desloge, MO 63601
Phone (573) 431-6677

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737763200000",
    "number": "1114917903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 N DESLOGE DR",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636012936",
            "telephone_number": "573-431-6677",
            "fax_number": "573-431-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 N DESLOGE DR",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636012936",
            "telephone_number": "573-431-6677",
            "fax_number": "573-431-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKLAND APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A",
        "authorized_official_last_name": "UMFLEET",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-431-6677",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2005028538",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049127",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606222008",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkland Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Desloge, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2025; 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.