Healthcare Provider Details

I. General information

NPI: 1528813961
Provider Name (Legal Business Name): CHASE COUNTY PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BROADWAY ST
COTTONWOOD FALLS KS
66845-9728
US

IV. Provider business mailing address

PO BOX D
COTTONWOOD FALLS KS
66845-0106
US

V. Phone/Fax

Practice location:
  • Phone: 620-220-6161
  • Fax: 620-220-6162
Mailing address:
  • Phone: 620-220-6161
  • Fax: 620-220-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LANCE FREEMAN
Title or Position: OWNER
Credential:
Phone: 620-220-6161