MEDICARE: KEX RX FALLS CITY LLC

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	3336C0003X	Community/Retail Pharmacy	3012	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146319	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255756003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEX RX FALLS CITY LLC

Provider Business Mailing Address
First Line	:	101 S 6TH ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2306
Country	:	US
Telephone Number	:	785-742-2125
Fax Number	:	785-742-4551

Provider Business Practice Location Address
First Line	:	120 E 18TH ST
Second Line	:
City	:	FALLS CITY
State	:	NE
Zip	:	68355-2116
Country	:	US
Telephone Number	:	402-245-2029
Fax Number	:	800-558-2602

Authorized Official
Title or Position	:	OWNER,RPH,AO
Name	:	JOSEPH KOECHNER
Credential	:	RPH
Telephone Number	:	785-742-2125

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	07/12/2024

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