Healthcare Provider Details

I. General information

NPI: 1184690554
Provider Name (Legal Business Name): CHEYENNE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MAIN
HOISINGTON KS
67544-0446
US

IV. Provider business mailing address

PO BOX 446
HOISINGTON KS
67544-0446
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-2828
  • Fax: 620-653-4206
Mailing address:
  • Phone: 620-653-2828
  • Fax: 620-653-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-08220
License Number StateKS

VIII. Authorized Official

Name: MR. JAMES D SIEBERT
Title or Position: PRESIDENT
Credential: RPH
Phone: 620-653-2818