Healthcare Provider Details

I. General information

NPI: 1891703914
Provider Name (Legal Business Name): AV DRUG ACQUISITION CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11131 W 79TH ST
LENEXA KS
66214-1482
US

IV. Provider business mailing address

11131 W 79TH ST
LENEXA KS
66214-1482
US

V. Phone/Fax

Practice location:
  • Phone: 913-234-4664
  • Fax: 913-234-4665
Mailing address:
  • Phone: 913-234-4664
  • Fax: 913-234-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number209463
License Number StateKS

VIII. Authorized Official

Name: PHILIP F RELLIHAN
Title or Position: GENERAL MANAGER
Credential: RPH
Phone: 913-234-4664