Provider Demographics
NPI:1386665933
Name:AUBURN PHARMACY, INC.
Entity Type:Organization
Organization Name:AUBURN PHARMACY, INC.
Other - Org Name:AUBURN LTC NEVADA #240
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:259 W PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1080
Mailing Address - Country:US
Mailing Address - Phone:417-667-2500
Mailing Address - Fax:866-955-8122
Practice Address - Street 1:125 S WASHINGTON ST
Practice Address - Street 2:STE 200
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3329
Practice Address - Country:US
Practice Address - Phone:417-667-2500
Practice Address - Fax:866-955-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
MO20170423373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO608510707Medicaid
2174644OtherPK
MO608510707Medicaid
OK200004750AMedicaid
AR136226407Medicaid