MEDICARE: DEGOLER 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	2-09507	KS

General Provider Information

NPI Number	:	1710086731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEGOLER INC.

Provider Business Mailing Address
First Line	:	21 N 12TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-5161
Country	:	US
Telephone Number	:	913-342-4077
Fax Number	:	913-371-2802

Provider Business Practice Location Address
First Line	:	21 N 12TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-5161
Country	:	US
Telephone Number	:	913-342-4077
Fax Number	:	913-371-2802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLENN C. HARTE
Credential	:	PHARM.D.
Telephone Number	:	913-342-4077

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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Directions to “DEGOLER INC. ” Practice Location

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