MEDICARE: KOLLHOFF FAMILY PHARMACY LLC

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	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	2-12999	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2141965	OTHER		PK

General Provider Information

NPI Number	:	1467886796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLLHOFF FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	320 BROADWAY ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1302
Country	:	US
Telephone Number	:	785-945-3711
Fax Number	:	785-945-6156

Provider Business Practice Location Address
First Line	:	320 BROADWAY ST
Second Line	:
City	:	VALLEY FALLS
State	:	KS
Zip	:	66088-1302
Country	:	US
Telephone Number	:	785-945-3711
Fax Number	:	785-945-6156

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN KOLLHOFF
Credential	:
Telephone Number	:	855-945-9451

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	03/13/2015

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Directions to “KOLLHOFF FAMILY PHARMACY LLC ” Practice Location

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