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General NPI Number Information
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NPI Number | 1114448404
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Entity Type | Organization
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Legal Business Name | MYERS FAMILY CENTER PHARMACY
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 616 CEDAR ST
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City | CEDAR VALE
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State | KS
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Zip | 67024-9704
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Country | US
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Telephone | 620-758-2711
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Fax |
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Provider Business Mailing Address
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Address Line | 616 CEDAR ST
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City | CEDAR VALE
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State | KS
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Zip | 67024-9704
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Country | US
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Telephone | 620-758-2711
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DOUG BAGGETT
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Credential | DPH
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Telephone | 620-758-2711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 21103265
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2-103331
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2-103265
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License Number State | KS
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