MEDICARE: CANDLEWOOD PHARMACY LC

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

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

General Provider Information

NPI Number	:	1740274596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANDLEWOOD PHARMACY LC

Provider Business Mailing Address
First Line	:	3254 KIMBALL AVE
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-2157
Country	:	US
Telephone Number	:	785-776-4100
Fax Number	:	785-776-1039

Provider Business Practice Location Address
First Line	:	3254 KIMBALL AVE
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-2157
Country	:	US
Telephone Number	:	785-776-4100
Fax Number	:	785-776-1039

Authorized Official
Title or Position	:	PIC OWNER
Name	:	AMY HELLERICH
Credential	:	PHARMD
Telephone Number	:	785-776-4100

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	10/24/2023

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