MEDICARE: INDEPENDENCE PHARMACY

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	2-10199	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2116608	OTHER	PK

General Provider Information

NPI Number	:	1962658633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE PHARMACY

Provider Business Mailing Address
First Line	:	205 N PENN AVE
Second Line	:	PO BOX 71
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3323
Country	:	US
Telephone Number	:	620-331-3784
Fax Number	:	620-331-1701

Provider Business Practice Location Address
First Line	:	205 N PENN AVE
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3323
Country	:	US
Telephone Number	:	620-331-3784
Fax Number	:	620-331-1701

Authorized Official
Title or Position	:	PRES
Name	:	TERRY L. SCOTT
Credential	:
Telephone Number	:	620-331-3784

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	12/10/2019

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Directions to “INDEPENDENCE PHARMACY ” Practice Location

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