Healthcare Provider Details

I. General information

NPI: 1609203058
Provider Name (Legal Business Name): MONICAL DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S MAIN ST
CIMARRON KS
67835-8875
US

IV. Provider business mailing address

PO BOX 207
CIMARRON KS
67835-0207
US

V. Phone/Fax

Practice location:
  • Phone: 620-855-2242
  • Fax: 620-855-3616
Mailing address:
  • Phone: 620-855-2242
  • Fax: 620-855-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number213010
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DYLAN MONICAL
Title or Position: OWNER
Credential: PHARMD
Phone: 620-855-2242