C&P Viburnum Ventures LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2015037740 Issued in MO

Legal business name

C&P VIBURNUM VENTURES LLC

Doing business as

Iron County Drug Store

Practice address

1 Viburnum Center Rd Ste B
Viburnum, MO 65566-7802

Phone

(573) 244-3784

Fax

(573) 244-3700

NPI assigned

Sep 14, 2015

Last updated

Apr 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rebeca Walters-Peace

Title

Owner-RPH

Phone

(417) 778-6807

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Iron County Drug Store Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

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.

• David Combs

  • Pharmacist
  • Alton, MO
  • NPI 1528835816
  NPD
• Rebecca Lee Walters-Peace

  • Pharmacist
  • Alton, MO
  • NPI 1033985635
  NPD
• Theodore Joshua Olbricht

  • Pharmacist
  • Viburnum, MO
  • NPI 1730930165
  NPD (past)

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1184092793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 COUNTY ROAD 139",
            "city": "ALTON",
            "state": "MO",
            "postal_code": "656068221",
            "telephone_number": "573-244-3784",
            "fax_number": "573-244-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VIBURNUM CENTER RD STE B",
            "city": "VIBURNUM",
            "state": "MO",
            "postal_code": "655667802",
            "telephone_number": "573-244-3784",
            "fax_number": "573-244-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C&P VIBURNUM VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "WALTERS-PEACE",
        "authorized_official_first_name": "REBECA",
        "authorized_official_title_or_position": "OWNER-RPH",
        "authorized_official_telephone_number": "417-778-6807"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2015037740",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184092793",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2154621",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600027013",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iron County Drug Store",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iron County Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Big Springs Medical Association (Missouri Highlands Health Care)
• Susan L Byerley, FNP
• Disabled Citizens Alliance for Independence
• Disabled Citizens Alliance for Independence
• Disabled Citizens Alliance for Independence Foundation, Inc (DCAI Foundation)
• Iron County C-4 School District
• Iron County EMS

• Community/Retail Pharmacy in Viburnum, MO
• Providers in Viburnum, 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 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.