Provider Demographics
NPI:1073896874
Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Other - Org Name:CANCER CENTER PHARMACY SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-541-4651
Mailing Address - Street 1:ATTN: RETAIL PHARMACY SOUTH
Mailing Address - Street 2:9200 INDIAN CREEK PRKWY, BLDG 9, SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-541-4651
Mailing Address - Fax:913-577-5851
Practice Address - Street 1:1000 E 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3366
Practice Address - Country:US
Practice Address - Phone:816-823-6635
Practice Address - Fax:816-841-1242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF KANSAS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-28
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110177613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131972OtherPK