1255756003 NPI number — KEX RX FALLS CITY LLC

Table of content: (NPI 1255756003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255756003 NPI number — KEX RX FALLS CITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEX RX FALLS CITY LLC
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:
KEX RX PHARMACY & HOME CARE
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:
1255756003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66434-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-742-2125
Provider Business Mailing Address Fax Number:
785-742-4551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CITY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68355-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-245-2029
Provider Business Practice Location Address Fax Number:
402-245-2521
Provider Enumeration Date:
03/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOECHNER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER,RPH,AO
Authorized Official Telephone Number:
785-742-2125

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  3012 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100264047-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2146319 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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