Healthcare Provider Details

I. General information

NPI: 1457458069
Provider Name (Legal Business Name): AUBURN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54B SE 1ST LN
LAMAR MO
64759-9226
US

IV. Provider business mailing address

259 W PARK RD
GARNETT KS
66032-1080
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-5838
  • Fax: 417-682-5811
Mailing address:
  • Phone: 785-448-3600
  • Fax: 785-448-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2017039555
License Number StateMO

VIII. Authorized Official

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