Healthcare Provider Details

I. General information

NPI: 1679920698
Provider Name (Legal Business Name): RUSH COUNTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 MAIN ST
LA CROSSE KS
67548
US

IV. Provider business mailing address

PO BOX 100 708 MAIN STREET
LA CROSSE KS
67548-0100
US

V. Phone/Fax

Practice location:
  • Phone: 785-222-9091
  • Fax: 785-222-9096
Mailing address:
  • Phone: 785-222-9091
  • Fax: 785-222-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateKS

VIII. Authorized Official

Name: LISA E FLAX
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 785-222-9091