Provider Demographics
NPI:1437797529
Name:HUTCHINSON CLINIC P A INC
Entity Type:Organization
Organization Name:HUTCHINSON CLINIC P A INC
Other - Org Name:HUTCHINSON CLINIC PHARMACY ON MAIN LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ONTJES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-663-9542
Mailing Address - Street 1:1100 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4406
Mailing Address - Country:US
Mailing Address - Phone:620-669-6600
Mailing Address - Fax:620-669-6601
Practice Address - Street 1:2101 N WALDRON ST STE A
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1131
Practice Address - Country:US
Practice Address - Phone:620-663-9542
Practice Address - Fax:620-694-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100003360FMedicaid