Provider Demographics
NPI:1174637151
Name:PIERSON HANOVER PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:PIERSON HANOVER PROFESSIONAL PHARMACY
Other - Org Name:PIERSON HANOVER PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:785-337-2241
Mailing Address - Street 1:103 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945
Mailing Address - Country:US
Mailing Address - Phone:785-337-2241
Mailing Address - Fax:785-337-2202
Practice Address - Street 1:103 W NORTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-9065
Practice Address - Country:US
Practice Address - Phone:785-337-2241
Practice Address - Fax:785-337-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0002X
KS2-064193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031023OtherPK
KS100445300AMedicaid
4467710001Medicare NSC