Phillips Family Pharmacy, LLC
Organization Active NPI Community/Retail Pharmacy · Riverside, MO
NPI 1295075810 · NPPES record last updated Feb 28, 2023
Key facts
- NPI
- 1295075810
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2013005206 (MO)
- Legal business name
- PHILLIPS FAMILY PHARMACY, LLC
- Practice address
- 2101 NW Platte Rd
Riverside, MO 64150-9627 - Phone
- (816) 569-2125
- Fax
- (816) 569-5075
- NPI assigned
- Feb 19, 2013
- Organization subpart
- No
Authorized official
- Name
- Miss Josie D Phillips, PHARM.D.
- Title
- Pharmacist/Owner
- Phone
- (417) 766-9893
Practitioners 4
-
Ashley Kate Cummins, PHARMD
-
Josie Deeanna Ross, PHARM.D.
-
Jessica Smith, PHARMD
-
Robert Keith Fullmer, PHARM D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130619000058 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 1658510805 | Practice locations: Riverside, MO |
| O20220908001857 | MO | Part B Supplier - Pharmacy | 1658510805 | Practice locations: Riverside, MO |
National Provider Directory
Locations
2401 NW Platte Rd
Riverside, MO 64150
Phone (816) 569-2125
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 2013005206 | MO | Yes |
Addresses
Primary practice location
2101 NW Platte Rd
Riverside, MO 64150-9627
Mailing address
2101 NW Platte Rd
Riverside, MO 64150-9627
Phone (816) 569-2125
Other providers in Riverside, MO
- Robert Alan Mitchell
- Brittany Neri
- Morgan Lyn Newman
- Kirsten Osei
- Krishna Patel
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- Polaris Specialty Pharmacy LLC
- Polaris Specialty Pharmacy LLC
- Jessie Brei Riojas
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All providers in Riverside, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.