Healthcare Provider Details

I. General information

NPI: 1114972601
Provider Name (Legal Business Name): KOLLING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EISENHOWER DR
JUNCTION CITY KS
66441-3314
US

IV. Provider business mailing address

PO BOX 128
JUNCTION CITY KS
66441-0128
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-5535
  • Fax: 785-762-4277
Mailing address:
  • Phone: 785-762-5535
  • Fax: 785-762-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number209844
License Number StateKS

VIII. Authorized Official

Name: GARY KOLLING
Title or Position: OWNER
Credential: RPH
Phone: 785-762-5535