Healthcare Provider Details

I. General information

NPI: 1053423905
Provider Name (Legal Business Name): WOLKAR DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MILITARY AVE
BAXTER SPRINGS KS
66713-2039
US

IV. Provider business mailing address

1920 MILITARY AVE
BAXTER SPRINGS KS
66713-2039
US

V. Phone/Fax

Practice location:
  • Phone: 620-856-5555
  • Fax: 620-856-3455
Mailing address:
  • Phone: 620-856-5555
  • Fax: 620-856-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-13206
License Number StateKS

VIII. Authorized Official

Name: BRIAN CASWELL
Title or Position: PRESIDENT PHARMACIST IN CHARGE
Credential: RPH
Phone: 620-856-5555