Provider Demographics
NPI:1497741748
Name:DAUNER PHARMACIES CHTD
Entity Type:Organization
Organization Name:DAUNER PHARMACIES CHTD
Other - Org Name:MANKATO PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAUNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-378-3183
Mailing Address - Street 1:125 N COMMERCIAL ST
Mailing Address - Street 2:PO BOX 266
Mailing Address - City:MANKATO
Mailing Address - State:KS
Mailing Address - Zip Code:66956-2206
Mailing Address - Country:US
Mailing Address - Phone:785-378-3183
Mailing Address - Fax:785-378-3809
Practice Address - Street 1:125 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:KS
Practice Address - Zip Code:66956-2206
Practice Address - Country:US
Practice Address - Phone:785-378-3183
Practice Address - Fax:785-378-3809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAUNER PHARMACIES CHTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
KS7127333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100437380AMedicaid