Healthcare Provider Details

I. General information

NPI: 1174637151
Provider Name (Legal Business Name): PIERSON HANOVER PROFESSIONAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W NORTH ST
HANOVER KS
66945-9065
US

IV. Provider business mailing address

103 W NORTH ST
HANOVER KS
66945
US

V. Phone/Fax

Practice location:
  • Phone: 785-337-2241
  • Fax: 785-337-2202
Mailing address:
  • Phone: 785-337-2241
  • Fax: 785-337-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-06419
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE PIERSON
Title or Position: OWNER
Credential: BS PHARMACY
Phone: 785-337-2241