1184690554 NPI number — CHEYENNE DRUG INC

Table of content: (NPI 1184690554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184690554 NPI number — CHEYENNE DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEYENNE DRUG 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:
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:
1184690554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 446
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOISINGTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67544-0446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-653-2828
Provider Business Mailing Address Fax Number:
620-653-4206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOISINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67544-0446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-653-2828
Provider Business Practice Location Address Fax Number:
620-653-4206
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIEBERT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
620-653-2818

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2-08220 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1702910 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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