Provider Demographics
NPI:1093031502
Name:BB37 PA
Entity Type:Organization
Organization Name:BB37 PA
Other - Org Name:WELLINGTON HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-326-7455
Mailing Address - Street 1:505 E 16TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-2811
Mailing Address - Country:US
Mailing Address - Phone:620-326-7455
Mailing Address - Fax:620-326-2880
Practice Address - Street 1:505 E 16TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-2811
Practice Address - Country:US
Practice Address - Phone:620-326-7455
Practice Address - Fax:620-326-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
KS2-102923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200673880AMedicaid
2124654OtherPK