Healthcare Provider Details

I. General information

NPI: 1013072289
Provider Name (Legal Business Name): RCR EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N GREENWICH RD SUITE 1000
WICHITA KS
67226-8269
US

IV. Provider business mailing address

2350 N GREENWICH RD SUITE 1000
WICHITA KS
67226-8269
US

V. Phone/Fax

Practice location:
  • Phone: 316-636-9595
  • Fax: 316-636-9591
Mailing address:
  • Phone: 316-636-9595
  • Fax: 316-636-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number210265
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLAS L BRANAM
Title or Position: PIC
Credential: PHARM.D.
Phone: 316-636-9595