MEDICARE: DEFEVER OSBORN DRUG

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	183500000X	Pharmacist	209687	KS

General Provider Information

NPI Number	:	1790779460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEFEVER OSBORN DRUG

Provider Business Mailing Address
First Line	:	205 N PENN AVE
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3323
Country	:	US
Telephone Number	:	620-331-4200
Fax Number	:	620-331-8220

Provider Business Practice Location Address
First Line	:	205 N PENN AVE
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3323
Country	:	US
Telephone Number	:	620-331-4200
Fax Number	:	620-331-8220

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MS. WENDY D. DERRICK
Credential	:
Telephone Number	:	620-331-4200

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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Directions to “DEFEVER OSBORN DRUG ” Practice Location

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