Provider Demographics
NPI:1275721490
Name:MISSOURI-KANSAS ASSOC. OF MEDICINE SHOPPES
Entity Type:Organization
Organization Name:MISSOURI-KANSAS ASSOC. OF MEDICINE SHOPPES
Other - Org Name:MO KA ASSOC OF MED SHOPPE MK RAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SANTOSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:913-764-1800
Mailing Address - Street 1:539 E SANTA FE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3458
Mailing Address - Country:US
Mailing Address - Phone:913-764-1800
Mailing Address - Fax:913-764-9127
Practice Address - Street 1:539 E SANTA FE ST STE 8
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3458
Practice Address - Country:US
Practice Address - Phone:913-764-1800
Practice Address - Fax:913-764-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9004292Medicare PIN
KS9003917Medicare PIN