Hines Street Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2012001548 Issued in MO

Legal business name

HINES STREET PHARMACY LLC

Doing business as

Hines Street Pharmacy LLC

Practice address

1173 E Hines St
Republic, MO 65738-1277

Phone

(417) 735-0055

Fax

(417) 732-1529

NPI assigned

Dec 20, 2011

Last updated

Nov 24, 2020By 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. Stephen L McClanahan II, RPH.NPI 1487275707

Title

Owner

Phone

(417) 735-0055

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Hines Street Pharmacy LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Tax ID family

Hines Street Pharmacy LLC2 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.

• Hines Street Pharmacy LLC

  • Long Term Care Pharmacy
  • Republic, MO
  • NPI 1679252829
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Hines Street Pharmacy LLC

  • Long Term Care Pharmacy
  • Republic, MO
  • NPI 1679252829
  NPPES parent name

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.

• Stephen L McClanahan II, RPH.

  • Pharmacist
  • Republic, MO
  • NPI 1487275707
  Authorized official Same address or phone

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1740559764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 E HINES ST",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657381277",
            "telephone_number": "417-735-0055",
            "fax_number": "417-732-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 E HINES ST",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657381277",
            "telephone_number": "417-735-0055",
            "fax_number": "417-732-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HINES STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "MCCLANAHAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-735-0055",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2012001548",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133471",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609551700",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hines Street Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hines Street Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Healthy Roots Counseling, LLC
• David J Heitman, LPC
• Kathryn A. Herfkens-Ampleman, FNP
• Hines Street Pharmacy 2 LLC
• Hines Street Pharmacy LLC
• Martin Dale Hodges
• Amanda S Hoge
• Alexandria Paige Holmes, OD
• Drew Holtz, RPH
• Sharon Igou

• Community/Retail Pharmacy in Republic, MO
• Providers in Republic, 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 24, 2020; 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.