Healthcare Provider Details

I. General information

NPI: 1063469294
Provider Name (Legal Business Name): RAYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MAIN ST
QUINTER KS
67752
US

IV. Provider business mailing address

414 MAIN ST
QUINTER KS
67752-5205
US

V. Phone/Fax

Practice location:
  • Phone: 785-754-3312
  • Fax: 785-754-3844
Mailing address:
  • Phone: 785-754-3312
  • Fax: 785-754-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2-08129
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number208129
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100439990B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier2026129
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: DORIS TEBOW
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 785-754-3312