Healthcare Provider Details

I. General information

NPI: 1407862287
Provider Name (Legal Business Name): PHARMACY CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E. MAIN
COLDWATER KS
67029-0236
US

IV. Provider business mailing address

PO BOX 236 113 E. MAIN
COLDWATER KS
67029-0236
US

V. Phone/Fax

Practice location:
  • Phone: 620-582-2134
  • Fax: 620-582-2920
Mailing address:
  • Phone: 620-582-2134
  • Fax: 620-582-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-09647
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2-09647
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2-09647
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2-09647
License Number StateKS

VIII. Authorized Official

Name: DR. LISA GALES
Title or Position: PRESIDENT/OWNER
Credential: PHARM D
Phone: 620-582-2134