Provider Demographics
NPI:1467886796
Name:KOLLHOFF FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:KOLLHOFF FAMILY PHARMACY LLC
Other - Org Name:VALLEY FALLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-945-9451
Mailing Address - Street 1:320 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66088-1302
Mailing Address - Country:US
Mailing Address - Phone:785-945-3711
Mailing Address - Fax:785-945-6156
Practice Address - Street 1:320 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:KS
Practice Address - Zip Code:66088-1302
Practice Address - Country:US
Practice Address - Phone:785-945-3711
Practice Address - Fax:785-945-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336S0011X
KS2-129993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201083660AMedicaid
2141965OtherPK