Healthcare Provider Details

I. General information

NPI: 1194185512
Provider Name (Legal Business Name): QUIER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 11/22/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E ROSS ST STE 111
CLEARWATER KS
67026-7833
US

IV. Provider business mailing address

PO BOX 349
MEDICINE LODGE KS
67104-0349
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-3784
  • Fax: 620-886-5517
Mailing address:
  • Phone: 620-875-1345
  • Fax: 620-886-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-13234
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NANCY PETERSON BRADFIELD
Title or Position: PRESIDENT
Credential:
Phone: 785-466-6810