Healthcare Provider Details

I. General information

NPI: 1548367154
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: 12/24/2021
Certification Date: 12/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 14TH ST
RICH HILL MO
64779-2146
US

IV. Provider business mailing address

259 W PARK RD PO BOX 70
GARNETT KS
66032-1080
US

V. Phone/Fax

Practice location:
  • Phone: 417-395-4700
  • Fax: 417-395-2112
Mailing address:
  • Phone: 417-395-4700
  • Fax: 417-395-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2017035701
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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