Healthcare Provider Details

I. General information

NPI: 1093031502
Provider Name (Legal Business Name): BB37 PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 16TH ST SUITE 2
WELLINGTON KS
67152-2811
US

IV. Provider business mailing address

505 E 16TH ST SUITE #2
WELLINGTON KS
67152-2811
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-7455
  • Fax: 620-326-2880
Mailing address:
  • Phone: 620-326-7455
  • Fax: 620-326-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-10292
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY REED
Title or Position: PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 620-326-7455