Healthcare Provider Details

I. General information

NPI: 1861743130
Provider Name (Legal Business Name): KANSAS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E TULSA AVE
KANSAS OK
74347-7055
US

IV. Provider business mailing address

PO BOX 700
INOLA OK
74036-0700
US

V. Phone/Fax

Practice location:
  • Phone: 918-868-6162
  • Fax: 918-868-6167
Mailing address:
  • Phone: 918-543-8777
  • Fax: 918-543-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number45-6072
License Number StateOK

VIII. Authorized Official

Name: P. ANDREW TURNER
Title or Position: MEMBER
Credential:
Phone: 918-543-8777