KB Osceola Drug LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2016042638 Issued in MO

Legal business name

KB OSCEOLA DRUG LLC

Doing business as

Evans Drugs

Practice address

675 3Rd St
Osceola, MO 64776-2934

Phone

(417) 646-2301

Fax

(417) 646-2456

NPI assigned

Oct 20, 2016

Last updated

Apr 11, 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

Tracy Timmermann

Title

Manager,Ao

Phone

(417) 876-3313

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Evans Drugs Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586563200000",
    "number": "1831640275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 3RD ST",
            "city": "OSCEOLA",
            "state": "MO",
            "postal_code": "647762934",
            "telephone_number": "417-646-2301",
            "fax_number": "417-646-2456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 3RD ST",
            "city": "OSCEOLA",
            "state": "MO",
            "postal_code": "647762934",
            "telephone_number": "417-646-2301",
            "fax_number": "417-646-2456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KB OSCEOLA DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-20",
        "last_updated": "2020-04-11",
        "certification_date": "2020-04-11",
        "status": "A",
        "authorized_official_last_name": "TIMMERMANN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER,AO",
        "authorized_official_telephone_number": "417-876-3313"
    },
    "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": "2016042638",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600038893",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164581",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evans Drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evans Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ursula L Fuller, APRN, BC
• Golden Valley Memorial Hospital District (Golden Valley Medical - Osceola)
• Jeremy Lee Hicks, LMSW
• David Kenneth Holdenried, PHARMD
• Neil E Hoyal, M.D., D.O.
• Jill Nicole Keister
• Lester E Cox Medical Centers (Ferrell-Duncan Clinic)
• Jace David Moore, PHARMD
• Wayne L Morton, MD
• Osceola Public Schools

• Community/Retail Pharmacy in Osceola, MO
• Providers in Osceola, 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 Apr 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.