Provider Demographics
NPI:1033397716
Name:JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC
Entity Type:Organization
Organization Name:JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC
Other - Org Name:JAYHAWK PATIENT SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-228-9700
Mailing Address - Street 1:2620 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1868
Mailing Address - Country:US
Mailing Address - Phone:785-235-9700
Mailing Address - Fax:785-235-9703
Practice Address - Street 1:2620 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606
Practice Address - Country:US
Practice Address - Phone:785-235-9700
Practice Address - Fax:785-235-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X, 332BC3200X, 332BN1400X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100442610CMedicaid
KS48444OtherBCBSKS