Healthcare Provider Details

I. General information

NPI: 1609971670
Provider Name (Legal Business Name): STOCKTON PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST
STOCKTON KS
67669-1930
US

IV. Provider business mailing address

402 MAIN ST
STOCKTON KS
67669-1930
US

V. Phone/Fax

Practice location:
  • Phone: 785-425-7172
  • Fax: 785-425-6611
Mailing address:
  • Phone: 785-425-7172
  • Fax: 785-425-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09038
License Number StateKS

VIII. Authorized Official

Name: MR. RODNEY KENT HAHN
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential:
Phone: 785-425-7172