Pamida Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2006008264 Issued in MO

Legal business name

PAMIDA STORES OPERATING CO LLC

Doing business as

Pamida Pharmacy 853

Practice address

1021 W Buchanan St
California, MO 65018-1238

Phone

(573) 796-8002

Fax

(573) 796-8004

NPI assigned

Jun 4, 2006

Last updated

Nov 23, 2009By 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

Mr. John Harlow

Title

Ceo/President

Phone

(402) 596-7206

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pamida Pharmacy 853 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shopko Stores Operating Co LLC

  dba Shopko Pharmacy 718

  • Community/Retail Pharmacy
  • Liberty, KY
  • NPI 1508819384

  Member Of

  NPD member

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1336187707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W BUCHANAN ST",
            "city": "CALIFORNIA",
            "state": "MO",
            "postal_code": "650181238",
            "telephone_number": "573-796-8002",
            "fax_number": "573-796-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W BUCHANAN ST",
            "city": "CALIFORNIA",
            "state": "MO",
            "postal_code": "650181238",
            "telephone_number": "573-796-8002",
            "fax_number": "573-796-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMIDA STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "HARLOW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "402-596-7206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2006008264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602586109",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2635449",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamida Pharmacy 853",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Moniteau Mental Health Care
• N & R of California West, LLC (Moniteau Care Center)
• N & R of California, Inc. (California Care Center)
• Michelle Ann Nolph, ANP
• Pamida Stores Operating Co LLC (Pamida Pharmacy 853)
• Breanna Rae Pruitt
• Jill Denise Smith Radkowiec, OD
• Nicole E. Raithel
• Glenn R. Stenquist, D.D.S.
• Cole Edward Vanderfeltz, OD

• Community/Retail Pharmacy in California, MO
• Providers in California, 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 Nov 23, 2009; 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.