Provider Demographics
NPI:1437263415
Name:AUBURN PHARMACY, INC.
Entity Type:Organization
Organization Name:AUBURN PHARMACY, INC.
Other - Org Name:AUBURN PHARMACY #165
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:RPH
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:785-836-7202
Mailing Address - Fax:785-836-7208
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:KS
Practice Address - Zip Code:66414-9714
Practice Address - Country:US
Practice Address - Phone:785-836-7202
Practice Address - Fax:785-836-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X, 332B00000X
KS2-10443333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139993OtherPK
KS100439770MMedicaid
2139993OtherPK
KS0524000009Medicare NSC