Provider Demographics
NPI:1225124357
Name:STORMONT VAIL, INC.
Entity Type:Organization
Organization Name:STORMONT VAIL, INC.
Other - Org Name:STORMONT VAIL RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-354-6167
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:CORPORATE FINANCE
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6000
Mailing Address - Fax:
Practice Address - Street 1:2252 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3929
Practice Address - Country:US
Practice Address - Phone:785-235-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-088503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100443290AMedicaid
1707441OtherNCPDP OR NABP NUMBER