Provider Demographics
NPI:1073520748
Name:MEDICAL CENTER PHARMACY INC.
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY INC.
Other - Org Name:MOUNDRIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SCHOOLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-345-8650
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107-0318
Mailing Address - Country:US
Mailing Address - Phone:620-345-8650
Mailing Address - Fax:620-345-6312
Practice Address - Street 1:200 E. PACK
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107
Practice Address - Country:US
Practice Address - Phone:620-345-8650
Practice Address - Fax:620-345-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2097923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100437680AMedicaid
KS1714826OtherNCPDP
KS0210870002Medicare ID - Type Unspecified