Provider Demographics
NPI:1043317886
Name:FERGUSON REXALL DRUGS INC
Entity Type:Organization
Organization Name:FERGUSON REXALL DRUGS INC
Other - Org Name:FERGUSON REXALL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-632-3121
Mailing Address - Street 1:713 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-2936
Mailing Address - Country:US
Mailing Address - Phone:785-632-3121
Mailing Address - Fax:785-632-2440
Practice Address - Street 1:713 5TH ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-2936
Practice Address - Country:US
Practice Address - Phone:785-632-3121
Practice Address - Fax:785-632-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2077723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031305OtherPK
KS100439420AMedicaid
KS100439420AMedicaid