Provider Demographics
NPI:1346476900
Name:DOWNTOWN DRUGSTORE LLC
Entity Type:Organization
Organization Name:DOWNTOWN DRUGSTORE LLC
Other - Org Name:THE DOWNTOWN DRUGSTORE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BREUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-369-3800
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-0902
Mailing Address - Country:US
Mailing Address - Phone:913-369-3800
Mailing Address - Fax:913-369-3804
Practice Address - Street 1:516 E 4TH ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-8920
Practice Address - Country:US
Practice Address - Phone:913-369-3800
Practice Address - Fax:913-369-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-102453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120600OtherPK