Healthcare Provider Details

I. General information

NPI: 1083709026
Provider Name (Legal Business Name): JAYHAWK CUSTOM PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 SW 29TH ST
TOPEKA KS
66614-5650
US

IV. Provider business mailing address

6730 SW 29TH ST
TOPEKA KS
66614-5650
US

V. Phone/Fax

Practice location:
  • Phone: 785-228-9740
  • Fax: 785-228-9745
Mailing address:
  • Phone: 785-228-9740
  • Fax: 785-228-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number2-09414
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2-09414
License Number StateKS

VIII. Authorized Official

Name: MR. MICHAEL CONLIN
Title or Position: OWNER PHARMACIST
Credential: RPH.
Phone: 785-228-9740