NPIMap

Organization Active NPI

Elliott Pharmacy Inc

  • Community/Retail Pharmacy
  • Kirksville, MO
National Provider Identifier
1891700423
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
005972 Issued in MO
Legal business name
ELLIOTT PHARMACY INC
Doing business as
Elliott HealthMart Pharmacy
Practice address
2120 N Baltimore St
Kirksville, MO 63501-5109
Phone
(660) 665-9871
Fax
(660) 665-4332
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 005972 MO Primary

Addresses

Primary practice location

2120 N Baltimore St
Kirksville, MO 63501-5109

Mailing address

PO Box 72
Kirksville, MO 63501-0072
Phone (660) 665-9871

Other identifiers 2

IdentifierTypeStateIssuer
600398804MedicaidMO
2608187OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Elliott HealthMart Pharmacy 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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1891700423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635010072",
            "telephone_number": "660-665-9871",
            "fax_number": "660-665-4332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 N BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635015109",
            "telephone_number": "660-665-9871",
            "fax_number": "660-665-4332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOTT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "660-665-9871",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "005972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600398804",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2608187",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elliott HealthMart Pharmacy",
            "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 Apr 30, 2012; 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.