1033397716 NPI number — JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC

Table of content: (NPI 1033397716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033397716 NPI number — JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAYHAWK PHARMACY SERVICES AT MISSION WOODS 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:
Provider Other Organization Name Type Code:
6
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:
1033397716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 SW 6TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-1868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-235-9700
Provider Business Mailing Address Fax Number:
785-235-9703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 SW 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-235-9700
Provider Business Practice Location Address Fax Number:
785-235-9703
Provider Enumeration Date:
02/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONLIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-228-9700

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100442610C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48444 . This is a "BCBSKS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".