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: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
CIMARRON KS
67835-8856
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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number213010
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2143009
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier201089810A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: MATTHEW MONICAL
Title or Position: PRESIDENT
Credential:
Phone: 620-855-0922