Provider Demographics
NPI:1538635826
Name:AUBURN PHARMACY, INC.
Entity Type:Organization
Organization Name:AUBURN PHARMACY, INC.
Other - Org Name:AUBURN LTC LEBO #171L
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:LEBO
Mailing Address - State:KS
Mailing Address - Zip Code:66856-0025
Mailing Address - Country:US
Mailing Address - Phone:620-256-6122
Mailing Address - Fax:620-256-6117
Practice Address - Street 1:6 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBO
Practice Address - State:KS
Practice Address - Zip Code:66856-9709
Practice Address - Country:US
Practice Address - Phone:620-256-6122
Practice Address - Fax:620-256-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201174430HMedicaid