MEDICARE: ALDRICH APOTHECARY CHARTERED

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	3336C0003X	Community/Retail Pharmacy	2-07647	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2030744	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285714709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDRICH APOTHECARY CHARTERED

Provider Business Mailing Address
First Line	:	115 W MAIN ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1702
Country	:	US
Telephone Number	:	316-767-6800
Fax Number	:	620-767-6858

Provider Business Practice Location Address
First Line	:	115 W MAIN ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1702
Country	:	US
Telephone Number	:	620-767-6731
Fax Number	:	620-767-6858

Authorized Official
Title or Position	:	OWNER
Name	:	CONSTANCE ALDRICH
Credential	:
Telephone Number	:	620-767-6731

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/20/2016

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