Provider Demographics
NPI:1073589032
Name:GUYLL PHARMACY INC
Entity Type:Organization
Organization Name:GUYLL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUYLL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-331-0036
Mailing Address - Street 1:400 N PENN AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3012
Mailing Address - Country:US
Mailing Address - Phone:620-331-0036
Mailing Address - Fax:620-331-0593
Practice Address - Street 1:400 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3012
Practice Address - Country:US
Practice Address - Phone:620-331-0036
Practice Address - Fax:620-331-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7905333600000X, 3336L0003X
KS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439760AMedicaid
KS1714701OtherNCPDP #
KS1714701OtherNCPDP #