Provider Demographics
NPI:1447365549
Name:FOUR B CORP
Entity type:Organization
Organization Name:FOUR B CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-573-1294
Mailing Address - Street 1:5300 SPEAKER RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-1050
Mailing Address - Country:US
Mailing Address - Phone:913-573-1294
Mailing Address - Fax:913-551-8580
Practice Address - Street 1:500 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2879
Practice Address - Country:US
Practice Address - Phone:816-468-7666
Practice Address - Fax:816-436-0403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR B CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MO5403333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO623210705Medicaid
2051473OtherPK
MO603210709Medicaid
MO623210705Medicaid