Provider Demographics
NPI:1295140572
Name:B-PHARM, INC
Entity type:Organization
Organization Name:B-PHARM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-5535
Mailing Address - Street 1:1003 HIGHWAY 65 NORTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633
Mailing Address - Country:US
Mailing Address - Phone:660-886-5535
Mailing Address - Fax:660-886-6320
Practice Address - Street 1:1003 HIGHWAY 65 NORTH
Practice Address - Street 2:SUITE B
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633
Practice Address - Country:US
Practice Address - Phone:660-886-5535
Practice Address - Fax:660-886-6320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED CROSS PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-25
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0052293336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600053805Medicaid
MO600053805Medicaid