Provider Demographics
NPI:1104852672
Name:JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC
Entity Type:Organization
Organization Name:JAYHAWK PHARMACY SERVICES AT MISSION WOODS INC
Other - Org Name:JAYHAWK PHARMACY & PATIENT SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-228-9700
Mailing Address - Street 1:2860 SW MISSION WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5646
Mailing Address - Country:US
Mailing Address - Phone:785-228-9700
Mailing Address - Fax:785-228-1375
Practice Address - Street 1:2860 SW MISSION WOODS DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5646
Practice Address - Country:US
Practice Address - Phone:785-228-9700
Practice Address - Fax:785-228-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 332BX2000X
KS2-094013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1716248OtherNCPDP NUMBER
KS2-09401OtherSTATE PHARMACY LICENSE
KS100442610BMedicaid
KS100442610CMedicaid
KS4901260001Medicare NSC