Provider Demographics
NPI:1225257538
Name:RICHARDSONS PHARMACY
Entity Type:Organization
Organization Name:RICHARDSONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-721-2626
Mailing Address - Street 1:3510 N RIDGE RD
Mailing Address - Street 2:STE 920
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3510 N RIDGE RD
Practice Address - Street 2:STE 920
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1224
Practice Address - Country:US
Practice Address - Phone:316-721-2626
Practice Address - Fax:316-721-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
KS2098653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700598OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KS6014785701Medicaid
1700598OtherOTHER ID NUMBER