Healthcare Provider Details

I. General information

NPI: 1801964606
Provider Name (Legal Business Name): CANEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W 4TH AVE
CANEY KS
67333-1462
US

IV. Provider business mailing address

208 W 4TH AVE
CANEY KS
67333-1462
US

V. Phone/Fax

Practice location:
  • Phone: 620-879-5822
  • Fax: 620-879-2721
Mailing address:
  • Phone: 620-879-5822
  • Fax: 620-879-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GAVIN T DULEY
Title or Position: PRESIDENT
Credential:
Phone: 620-879-5822