Provider Demographics
NPI:1528106515
Name:SUGARSHIR INC
Entity type:Organization
Organization Name:SUGARSHIR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-827-2121
Mailing Address - Street 1:704 S HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4638
Mailing Address - Country:US
Mailing Address - Phone:660-827-2121
Mailing Address - Fax:660-826-0687
Practice Address - Street 1:704 S HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-4638
Practice Address - Country:US
Practice Address - Phone:660-827-2121
Practice Address - Fax:660-826-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004866333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600118707Medicaid
2625347OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MOBT1483825OtherDEA #