Parkland Pharmacy Development LLC
Organization Active NPI Community/Retail Pharmacy · Ironton, MO
NPI 1669814182 · NPPES record last updated Jan 25, 2025
Key facts
- NPI
- 1669814182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2013024667 (MO)
- Legal business name
- PARKLAND PHARMACY DEVELOPMENT LLC
- Practice address
- 1500 N Highway 21
Ironton, MO 63650-9147 - Phone
- (573) 546-6000
- Fax
- (573) 546-6001
- NPI assigned
- Jul 25, 2013
- Organization subpart
- No
Authorized official
- Name
- Lisa Umfleet, RPH
- Title
- Secretary of LLC, Owner
- Phone
- (573) 747-8333
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 2
Practitioners 1
-
Lisa Kay Umfleet, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140211000109 | MO | DME Supplier - Pharmacy | 8325284714 | Practice locations: Ironton, MO |
| O20140429001695 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325284714 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fredericktown, MO; Ironton, MO |
| O20200821000797 | MO | Part B Supplier - Pharmacy | 8325284714 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Piedmont, MO; Ironton, MO; Greenville, MO; Fredericktown, MO; Desloge, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2013024667 | MO | Yes |
Addresses
Primary practice location
1500 N Highway 21
Ironton, MO 63650-9147
Mailing address
1025 Highway 72 Byp
Fredericktown, MO 63645-7326
Phone (573) 783-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669814182 | Medicaid | MO | |
| 2140129 | Other | PK |
Other names
- Parkland Pharmacy
Other providers in Ironton, MO
- Sylvia Martin
- Steven F McAdams
- Missouri CVS Pharmacy, L.L.C.
- Kathleen Noetzel
- Tricia Parker
- Erika Michelle Parks
- Scenic View LLC
- Christopher Shawn Skinner
- Southeast Missouri Behavioral Health
- Melissa Ann Stetina
All providers in Ironton, 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 Jan 25, 2025. 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.