Provider Demographics
NPI:1306846720
Name:HOFFMAN PHARMACY INC
Entity Type:Organization
Organization Name:HOFFMAN PHARMACY INC
Other - Org Name:MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:J. DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-421-0882
Mailing Address - Street 1:2701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2644
Mailing Address - Country:US
Mailing Address - Phone:620-421-0882
Mailing Address - Fax:
Practice Address - Street 1:2701 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2644
Practice Address - Country:US
Practice Address - Phone:620-421-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2078233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439560AMedicaid
KS100441340AMedicaid
1714600OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1714600OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0228250001Medicare NSC