1255470191 NPI number — AUBURN PHARMACY, INC.

Table of content: (NPI 1255470191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255470191 NPI number — AUBURN PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUBURN PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AUBURN PHARMACY #127
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255470191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 W PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNETT
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66032-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-393-4440
Provider Business Mailing Address Fax Number:
913-393-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20375 W 151ST ST
Provider Second Line Business Practice Location Address:
STE 100A
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-393-4440
Provider Business Practice Location Address Fax Number:
913-393-4441
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
785-448-3600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2-100544 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100439770U , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100439770V , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2162338 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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