MEDICARE: WALTERSCHEID PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	7829	KS
2	333600000X	Pharmacy	7829	KS
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1714624	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043382831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTERSCHEID PHARMACY INC

Provider Business Mailing Address
First Line	:	1001 W 11TH ST
Second Line	:
City	:	COFFEYVILLE
State	:	KS
Zip	:	67337-4220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W 11TH ST
Second Line	:
City	:	COFFEYVILLE
State	:	KS
Zip	:	67337-4220
Country	:	US
Telephone Number	:	620-251-2150
Fax Number	:	620-251-0022

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	PETER WALTERSCHEID
Credential	:	RPH
Telephone Number	:	620-251-2150

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/07/2023

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Directions to “WALTERSCHEID PHARMACY INC ” Practice Location

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