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General NPI Number Information
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NPI Number | 1619966272
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Entity Type | Organization
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Legal Business Name | PRESCRIPTION SHOP, INC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 601 W 11TH ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-5025
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Country | US
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Telephone | 620-251-1620
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Fax | 620-251-4730
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Provider Business Mailing Address
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Address Line | 601 W 11TH ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-5025
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Country | US
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Telephone | 620-251-1620
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Fax | 620-251-4730
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Authorized Official
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Title or Position | OWNER
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Name | ALAN DEFEVER
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Credential | RPH
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Telephone | 913-515-0462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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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 | 209131
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License Number State | KS
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