Provider Demographics
NPI:1043382831
Name:WALTERSCHEID PHARMACY INC
Entity Type:Organization
Organization Name:WALTERSCHEID PHARMACY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-251-2150
Mailing Address - Street 1:1001 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-4220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W 11TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4220
Practice Address - Country:US
Practice Address - Phone:620-251-2150
Practice Address - Fax:620-251-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7829332B00000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100247770AMedicaid
1714624OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KS100443690AMedicaid
KS100443690AMedicaid
OK100247770AMedicaid