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>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1568915072

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 620-886-3275  Fax: 620-886-5443

Contact information for business:
909 N CEDAR ST P. O. BOX 367 MEDICINE LODGE, KS 67104-1032 US
Tel: 620-886-3275  Fax: 620-886-5443

Registration Information:
NPI: 1568915072
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
N183500000XPharmacy Service Providers

Legacy codes, insurance codes and state license numbers:



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