Provider Demographics
NPI:1114071297
Name:PARKLANE PHARMACY PA
Entity Type:Organization
Organization Name:PARKLANE PHARMACY PA
Other - Org Name:PARKLANE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERD PHARMACIST
Authorized Official - Phone:316-685-2269
Mailing Address - Street 1:1530 S OLIVER
Mailing Address - Street 2:STE 141
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3240
Mailing Address - Country:US
Mailing Address - Phone:316-685-2269
Mailing Address - Fax:316-685-2621
Practice Address - Street 1:1530 S OLIVER
Practice Address - Street 2:STE 141
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3240
Practice Address - Country:US
Practice Address - Phone:316-685-2269
Practice Address - Fax:316-685-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7407183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10043B470BMedicaid
KS10043B470BMedicaid