Provider Demographics
NPI:1003804584
Name:EDLER PHARMACY, P.A.
Entity Type:Organization
Organization Name:EDLER PHARMACY, P.A.
Other - Org Name:STARK EDLER APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-541-5050
Mailing Address - Street 1:10600 QUIVIRA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2309
Mailing Address - Country:US
Mailing Address - Phone:913-541-5050
Mailing Address - Fax:913-541-6021
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-5050
Practice Address - Fax:913-541-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-10201333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200575380AMedicaid
KS5375070001Medicare NSC