Healthcare Provider Details

I. General information

NPI: 1245007855
Provider Name (Legal Business Name): MATHIS DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W SAINT JOHN ST
GIRARD KS
66743-1213
US

IV. Provider business mailing address

400 W SAINT JOHN ST
GIRARD KS
66743-1213
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-4313
  • Fax: 620-724-6900
Mailing address:
  • Phone: 620-724-4313
  • Fax: 620-724-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM EARL OSBORN
Title or Position: SECRETARY
Credential:
Phone: 918-542-4444