MEDICARE: DEGOLERS 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	3336C0003X	Community/Retail Pharmacy	2-10351	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2131783	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457446437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEGOLERS INC

Provider Business Mailing Address
First Line	:	111 OAK ST
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-1049
Country	:	US
Telephone Number	:	913-422-3066
Fax Number	:	913-422-7050

Provider Business Practice Location Address
First Line	:	202 OAK ST
Second Line	:
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-1029
Country	:	US
Telephone Number	:	913-422-3066
Fax Number	:	913-422-7050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLENN HARTE
Credential	:
Telephone Number	:	913-596-2447

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/20/2013

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Directions to “DEGOLERS INC ” Practice Location

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