Kiko Enterprises, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

005448 Issued in MO

Legal business name

KIKO ENTERPRISES, LLC

Practice address

920 H St Clair Plaza Dr
St Clair, MO 63077

Phone

(636) 629-2022

Fax

(636) 629-2082

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Martin HinterlongNPI 1093044380

Title

Owner

Phone

(636) 629-2022

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• The Medicine Shoppe Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martin J Hinterlong

  • Pharmacist
  • Saint Clair, MO
  • NPI 1093044380
  NPD Authorized official
• Anthony Riemann

  • Pharmacist
  • Saint Clair, MO
  • NPI 1740877349
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1821162280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 M ST CLAIR PLAZA DR",
            "city": "ST CLAIR",
            "state": "MO",
            "postal_code": "63077",
            "telephone_number": "636-629-2022",
            "fax_number": "636-629-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 H ST CLAIR PLAZA DR",
            "city": "ST CLAIR",
            "state": "MO",
            "postal_code": "63077",
            "telephone_number": "636-629-2022",
            "fax_number": "636-629-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIKO ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "HINTERLONG",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-629-2022"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "005448",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2051500",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602188203",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathleen Herndon, PT
• Martin J Hinterlong
• Mary Lynne Jackson, RPH
• Grace Kelley
• Haley Kelly, CCC-SLP
• Kirk E. Brockman M.D. Dba St. Clair Medical Center
• Sheri Knight
• Susan Elizabeth Lindemann, R.PH.
• Charlotte A Liston, OTR/L
• Living Well Home Care, LLC

• All providers in St Clair, MO
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; 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.