Provider Demographics
NPI:1861712630
Name:RED CROSS PHARMACY
Entity type:Organization
Organization Name:RED CROSS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-5535
Mailing Address - Street 1:52 E ARROW ST
Mailing Address - Street 2:P.O. BOX 917
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2101
Mailing Address - Country:US
Mailing Address - Phone:660-886-5535
Mailing Address - Fax:660-886-6320
Practice Address - Street 1:2400 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2666
Practice Address - Country:US
Practice Address - Phone:888-635-4485
Practice Address - Fax:816-628-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600305213Medicaid