Healthcare Provider Details

I. General information

NPI: 1073520748
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E. PACK
MOUNDRIDGE KS
67107
US

IV. Provider business mailing address

PO BOX 318
MOUNDRIDGE KS
67107-0318
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-8650
  • Fax: 620-345-6312
Mailing address:
  • Phone: 620-345-8650
  • Fax: 620-345-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number209792
License Number StateKS

VIII. Authorized Official

Name: MR. ALAN KEITH SCHOOLER
Title or Position: SECRETARY
Credential: RPH
Phone: 620-345-8650