Healthcare Provider Details

I. General information

NPI: 1306932777
Provider Name (Legal Business Name): WITMER DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 3RD ST
PHILLIPSBURG KS
67661-1915
US

IV. Provider business mailing address

779 3RD ST
PHILLIPSBURG KS
67661-1915
US

V. Phone/Fax

Practice location:
  • Phone: 785-543-2032
  • Fax: 785-543-2472
Mailing address:
  • Phone: 785-543-2032
  • Fax: 785-543-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8735
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BAILEY IMM
Title or Position: PIC
Credential: PHARMD
Phone: 785-543-2032