Healthcare Provider Details

I. General information

NPI: 1760170690
Provider Name (Legal Business Name): ASHCRAFT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST
SOUTH HUTCHINSON KS
67505-1123
US

IV. Provider business mailing address

601 E IRON AVE
SALINA KS
67401-3035
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-2258
  • Fax: 620-663-8340
Mailing address:
  • Phone: 785-827-4455
  • Fax: 785-827-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KYNAN GIBSON
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 785-827-4455