KB Kirksville Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2016029935 Issued in MO

Legal business name

KB KIRKSVILLE PHARMACY LLC

Practice address

1611 S Baltimore St
Kirksville, MO 63501-4518

Phone

(660) 956-7010

Fax

(660) 956-7015

NPI assigned

Jun 13, 2016

Organization subpart

No

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

Authorized official

Name

Tracy Timmermann, RPH

Title

Manager/Ao

Phone

(417) 876-3313

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• KIRKSVILLE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

Tax ID family

KB Kirksville Pharmacy LLC2 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.

• KB Kirksville Pharmacy LLC

  • Long Term Care Pharmacy
  • Kirksville, MO
  • NPI 1326684689
  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.

• Chase Boucher, PHARMD

  • Pharmacist
  • Chesterfield, MO
  • NPI 1679014245
  NPD (past)
• Levi Russell Blanck, PHARMD

  • Pharmacist
  • Lenexa, KS
  • NPI 1467193359
  NPD (past)

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1134579923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "address_2": "STE B",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014518",
            "telephone_number": "660-956-7010",
            "fax_number": "660-956-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014518",
            "telephone_number": "660-956-7010",
            "fax_number": "660-956-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KB KIRKSVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-13",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "TIMMERMANN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER/AO",
        "authorized_official_telephone_number": "417-876-3313",
        "authorized_official_credential": "RPH"
    },
    "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": "2016029935",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160612",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600035560",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIRKSVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KIRKSVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mathew Michael Jury, DO
• K. Sylvara Family Practice, L.L.C
• Kansas City Vamc
• Ming-Tse Kao, DO
• Caitlin Alexis Hannah Kauff
• KB Kirksville Pharmacy LLC
• Karlin E Kean, LMSW
• Brenda Kay Kelley, PTA
• Shawnee Lynn Kellison, RNBCFNP
• Kelly D. Burchett DO LLC

• Community/Retail Pharmacy in Kirksville, MO
• Providers in Kirksville, 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 Apr 2, 2020; 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.