=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770508681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATZER PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 W MAIN ST
-----------------------------------------------------
City | CHANUTE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66720-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
Fax | 620-431-7741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 W MAIN ST PO BOX C
-----------------------------------------------------
City | CHANUTE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66720-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
Fax | 620-431-7741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. NICHOLAS KENT GALEMORE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 2-09517
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------