Healthcare Provider Details

I. General information

NPI: 1902958531
Provider Name (Legal Business Name): AUBURN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 E 23RD ST S
INDEPENDENCE MO
64055-1922
US

IV. Provider business mailing address

259 W PARK RD
GARNETT KS
66032-1080
US

V. Phone/Fax

Practice location:
  • Phone: 816-833-8629
  • Fax: 816-833-8634
Mailing address:
  • Phone: 816-833-8629
  • Fax: 816-833-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2017035331
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BURNS
Title or Position: OWNER
Credential: RPH
Phone: 785-448-3600