NPIMap

Organization Active NPI

Parkland Pharmacy Development LLC

Doing business as Parkland Pharmacy

  • Community/Retail Pharmacy
  • Fredericktown, MO
National Provider Identifier
1366704876
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2012034351 Issued in MO
Legal business name
PARKLAND PHARMACY DEVELOPMENT LLC
Doing business as
Parkland Pharmacy
Practice address
1025 E Highway 72 Byp
Fredericktown, MO 63645-7326
Phone
(573) 783-6000
Fax
(573) 783-6008
NPI assigned
Jun 11, 2012
Last updated
Jan 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Authorized official

Name
Jeremy Leach, RPHNPI 1629417340
Title
Owner
Phone
(573) 783-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 2012034351 MO Primary

Addresses

Primary practice location

1025 E Highway 72 Byp
Fredericktown, MO 63645-7326

Mailing address

1025 E Highway 72 Byp
Fredericktown, MO 63645-7326
Phone (573) 783-6000

Other identifiers 1

IdentifierTypeStateIssuer
2137194OtherPK

Other names 1

  • Parkland Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130409000029 MO DME Supplier - Pharmacy 8325284714 Practice locations: Fredericktown, MO
O20140429001695 MO Part B Supplier - Mass Immunization (Roster Biller Only) 8325284714 1 other NPI on this enrollment
Practice locations: Fredericktown, MO; Ironton, MO
O20200821000797 MO Part B Supplier - Pharmacy 8325284714 3 other NPIs on this enrollment
Practice locations: Piedmont, MO; Ironton, MO; Greenville, MO; Fredericktown, MO; Desloge, MO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1025 Highway 72 Byp
Fredericktown, MO 63645
Phone (573) 431-6677

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737763200000",
    "number": "1366704876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 E HIGHWAY 72 BYP",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636457326",
            "telephone_number": "573-783-6000",
            "fax_number": "573-783-6008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 E HIGHWAY 72 BYP",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636457326",
            "telephone_number": "573-783-6000",
            "fax_number": "573-783-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKLAND PHARMACY DEVELOPMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-783-6000",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2012034351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137194",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkland Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericktown, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2025; 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.