1427023480 NPI number — C & R CLINIC PHARMACY INC. OF ELKHART

Table of content: (NPI 1427023480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427023480 NPI number — C & R CLINIC PHARMACY INC. OF ELKHART

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C & R CLINIC PHARMACY INC. OF ELKHART
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:
1427023480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 962
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67950-0962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-697-2131
Provider Business Mailing Address Fax Number:
620-697-4643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 SUNSET DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67950-0962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-697-2131
Provider Business Practice Location Address Fax Number:
620-697-4643
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PHARMACIST IN CHARGE
Authorized Official Telephone Number:
620-697-2131

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  6590 , 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: 93725248 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100245910A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100438580A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710640 . This is a "NCPDP PHARMACY NUMBER" identifier . This identifiers is of the category "OTHER".




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