Provider Demographics
NPI:1083728067
Name:UNREIN DRUG, INC.
Entity Type:Organization
Organization Name:UNREIN DRUG, INC.
Other - Org Name:UNREIN DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:UNREIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-434-4615
Mailing Address - Street 1:210 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-2227
Mailing Address - Country:US
Mailing Address - Phone:785-434-4615
Mailing Address - Fax:785-434-4895
Practice Address - Street 1:210 W MILL ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-2227
Practice Address - Country:US
Practice Address - Phone:785-434-4615
Practice Address - Fax:785-434-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2079893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100434560AMedicaid
1704851OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KS100434560AMedicaid