NPIMap

Organization Active NPI

Elliott Pharmacy Inc

  • Long Term Care Pharmacy
  • Kirksville, MO
National Provider Identifier
1467609636
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
2008018246 Issued in MO
Legal business name
ELLIOTT PHARMACY INC
Doing business as
Elliott Pharmacy LTC
Practice address
2120A North Baltimore
Kirksville, MO 63501
Phone
(660) 665-9871
Fax
(660) 665-4332
NPI assigned
Aug 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Authorized official

Name
Jeffrey Nelson
Title
Owner
Phone
(660) 665-9871

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 2008018246 MO Primary

Addresses

Primary practice location

2120A North Baltimore
Kirksville, MO 63501

Mailing address

PO Box 729
Kirksville, MO 63501-0729
Phone (660) 665-9871

Other identifiers 2

IdentifierTypeStateIssuer
1467609636MedicaidMO
2638166OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Elliott Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elliott Healthmart Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2120 N Baltimore St
#A
Kirksville, MO 63501
Phone (660) 665-9871

NPI Registry JSON

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1467609636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635010729",
            "telephone_number": "660-665-9871",
            "fax_number": "660-665-9871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120A NORTH BALTIMORE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "63501",
            "telephone_number": "660-665-9871",
            "fax_number": "660-665-4332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOTT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-19",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-665-9871"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2008018246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467609636",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2638166",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elliott Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.