Stadium Pharmacy

LBN: Ivna Medical Group Llc
Stadium Pharmacy is an health care organization with primary practice located at 4811 S Arrowhead Dr , Independence MO 64055-6981. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Ivna Medical Group Llc can be contacted via phone (816) 356-4600, or through Anneboina, Vikranth via phone (816) 356-4600.

Contact Information

Primary practice address
4811 S Arrowhead Dr Independence MO 64055-6981
Phone: (816) 356-4600
Fax: (816) 353-7296
Website:
Map and Directions
Authorized official contact:
Name: Anneboina, Vikranth
Phone: (816) 356-4600

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 2016039188 Missouri

Profile Details

NPI number 1013062090
LBN Legal business name Ivna Medical Group Llc
DBA Doing business as Stadium Pharmacy
Authorized official Anneboina, Vikranth
Entity Organization
Organization subpart 1 No
Enumeration date Jan 23rd, 2007
Last updated Apr 28th, 2017 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013062090 NPPES
Other 2166225 PK
MEDICAID 605454206 PK

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