Provider Demographics
NPI:1053496984
Name:PRAIRIE VIEW INC.
Entity Type:Organization
Organization Name:PRAIRIE VIEW INC.
Other - Org Name:PRAIRIE VIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOYCE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-284-6348
Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5010
Mailing Address - Country:US
Mailing Address - Phone:316-284-6348
Mailing Address - Fax:316-284-6349
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5010
Practice Address - Country:US
Practice Address - Phone:316-284-6348
Practice Address - Fax:316-284-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS209698333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100005670EMedicaid
1711452OtherNCPDP IDENTIFICATION