Provider Demographics
NPI:1194185512
Name:QUIER PHARMACY LLC
Entity Type:Organization
Organization Name:QUIER PHARMACY LLC
Other - Org Name:CLEARWATER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:PETERSON
Authorized Official - Last Name:BRADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-466-6810
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LODGE
Mailing Address - State:KS
Mailing Address - Zip Code:67104-0349
Mailing Address - Country:US
Mailing Address - Phone:620-875-1345
Mailing Address - Fax:620-886-5517
Practice Address - Street 1:130 E ROSS ST STE 111
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7833
Practice Address - Country:US
Practice Address - Phone:620-584-3784
Practice Address - Fax:620-886-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-13234333600000X, 333600000X
3336C0003X, 3336I0012X, 3336I0012X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158321OtherPK
KS201128690AMedicaid