=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104905876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEVENTH ST PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 N MAIN ST STE B
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66733-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-244-3333
-----------------------------------------------------
Fax | 620-244-3334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9830
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84109-9830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-244-3333
-----------------------------------------------------
Fax | 620-244-3334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BARBARA SMITH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 620-244-3333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 2-10250
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------