Provider Demographics
NPI:1447362447
Name:CHOICE PHARMACY SYSTEMS LLC
Entity type:Organization
Organization Name:CHOICE PHARMACY SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-PI
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-931-9111
Mailing Address - Street 1:6437 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2378
Mailing Address - Country:US
Mailing Address - Phone:816-505-4410
Mailing Address - Fax:816-505-4411
Practice Address - Street 1:6437 N COSBY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2378
Practice Address - Country:US
Practice Address - Phone:816-505-4410
Practice Address - Fax:877-908-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020161513336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO605864305Medicaid
2048815OtherPK
MO605864305Medicaid