Provider Demographics
NPI:1104859487
Name:THE ONAGA PHARMACY
Entity Type:Organization
Organization Name:THE ONAGA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-889-7181
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:300 LEONARD STREET
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-0153
Mailing Address - Country:US
Mailing Address - Phone:785-889-7181
Mailing Address - Fax:785-889-4452
Practice Address - Street 1:300 LEONARD STREET
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-0153
Practice Address - Country:US
Practice Address - Phone:785-889-7181
Practice Address - Fax:785-889-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08634333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100440330AMedicaid
KS100440330AMedicaid