Healthcare Provider Details

I. General information

NPI: 1104900364
Provider Name (Legal Business Name): AUBURN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date: 01/09/2007
Reactivation Date: 04/06/2007

III. Provider practice location address

606 E MOUNT VERNON BLVD
MOUNT VERNON MO
65712-9100
US

IV. Provider business mailing address

259 W PARK RD
GARNETT KS
66032-1080
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-2000
  • Fax: 417-466-2028
Mailing address:
  • Phone: 785-448-3600
  • Fax: 785-448-3600

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 Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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