Provider Demographics
NPI:1326116302
Name:DEP,INC.
Entity Type:Organization
Organization Name:DEP,INC.
Other - Org Name:THE MEDICINE SHOPPE #1293
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PISTOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-3410
Mailing Address - Street 1:2409 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2618
Mailing Address - Country:US
Mailing Address - Phone:620-231-3410
Mailing Address - Fax:620-231-3810
Practice Address - Street 1:2409 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2618
Practice Address - Country:US
Practice Address - Phone:620-231-3410
Practice Address - Fax:620-231-3810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-083923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1704825OtherNCPDP
KS100445440AMedicaid
MO608257309Medicaid
KS4597380001Medicare ID - Type UnspecifiedPART B SUPPLIER #