1306840855 NPI number — WEIMER DRUG CO., INC.

Table of content: (NPI 1306840855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306840855 NPI number — WEIMER DRUG CO., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEIMER DRUG CO., 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:
PATTERSON HEALTH MART PHARMACY
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:
1306840855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAY CENTER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67432-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-632-3115
Provider Business Mailing Address Fax Number:
785-632-3777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-3115
Provider Business Practice Location Address Fax Number:
785-632-3777
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
NOLAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-632-3115

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2-07255 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 2-07255 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 207255 , 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: 100435190B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000010362 . This is a "BCBS OF KS DME" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KA1546 . This is a "MEDICARE PTAN: KA1546 - WPS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100435190A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1701831 . This is a "NCPDP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0000050410 . This is a "BCBS OF KS PHARMACY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1821119306 . This is a "NPI FOR DME" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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