MEDICARE: JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	3336C0003X	Community/Retail Pharmacy	2-09401	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1716248	OTHER	KS	NCPDP NUMBER
2	2-09401	OTHER	KS	STATE PHARMACY LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104852672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC

Provider Business Mailing Address
First Line	:	2860 SW MISSION WOODS DR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-5646
Country	:	US
Telephone Number	:	785-228-9700
Fax Number	:	785-228-1375

Provider Business Practice Location Address
First Line	:	2860 SW MISSION WOODS DR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-5646
Country	:	US
Telephone Number	:	785-228-9700
Fax Number	:	785-228-1375

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL CONLIN
Credential	:	RPH
Telephone Number	:	785-228-9700

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	04/19/2023

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