Ivna Pharmacy Services LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2017040100 Issued in MO

Legal business name

IVNA PHARMACY SERVICES LLC

Doing business as

Stadium Pharmacy

Practice address

1741 NE Douglas St Ste 102
Lees Summit, MO 64086-4704

Phone

(636) 544-4525

NPI assigned

Nov 13, 2017

Last updated

Jun 16, 2018By 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

Vikranth K Anneboina

Title

Owner

Phone

(636) 544-4525

Specialties & licenses 1

Addresses

Other names 1

• Stadium Pharmacy Doing business as

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1265945216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 NE DOUGLAS ST STE 102",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 NE DOUGLAS ST STE 102",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864704",
            "telephone_number": "636-544-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVNA PHARMACY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ANNEBOINA",
        "authorized_official_first_name": "VIKRANTH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-544-4525"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2017040100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stadium Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Intrathecal Consultant Services
• John Calvin Ireland, D.O.
• Steven R Irwin, DDS
• Isd Lees Summit LLC (Lees Summit Renal Center)
• Michael George Ivancic, MD
• Anusha Gopalakrishnan Iyer, M.B.B.S
• J and E Dental LLC (Summit Dental Studio)
• J O Johnson DO PC
• Courtney J Jack, APRN-BC
• Jackson County Eye Clinic Inc. (Eyecare Associates of Lee's Summit)

• Community/Retail Pharmacy in Lee's Summit, MO
• Providers in Lee's Summit, 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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.