=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215087507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANSING PHARMACY LC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 01/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 EXPRESS LN SUITE A
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66043-1383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-250-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6680
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64064-6680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-777-0609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | ROBERT WINTERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-777-0609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 2-10127
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------