Healthcare Provider Details

I. General information

NPI: 1992874630
Provider Name (Legal Business Name): MASCHINO DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MAIN
PLEASANTON KS
66075-0500
US

IV. Provider business mailing address

PO BOX 500
PLEASANTON KS
66075-0500
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8733
  • Fax: 913-352-8120
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number209930
License Number StateKS

VIII. Authorized Official

Name: DOUG MASCHINO
Title or Position: OWNER
Credential:
Phone: 913-352-8733