Healthcare Provider Details

I. General information

NPI: 1285714709
Provider Name (Legal Business Name): ALDRICH APOTHECARY CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W MAIN ST
COUNCIL GROVE KS
66846-1702
US

IV. Provider business mailing address

115 W MAIN ST
COUNCIL GROVE KS
66846-1702
US

V. Phone/Fax

Practice location:
  • Phone: 620-767-6731
  • Fax: 620-767-6858
Mailing address:
  • Phone: 316-767-6800
  • Fax: 620-767-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-07647
License Number StateKS

VIII. Authorized Official

Name: CONSTANCE ALDRICH
Title or Position: OWNER
Credential:
Phone: 620-767-6731