Provider Demographics
NPI:1558645556
Name:ASSURED PHARMACY KANSAS INC
Entity Type:Organization
Organization Name:ASSURED PHARMACY KANSAS INC
Other - Org Name:CORDANT PHARMACY #9
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:303-749-0490
Mailing Address - Street 1:12015 E 46TH AVE
Mailing Address - Street 2:STE. 650
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3116
Mailing Address - Country:US
Mailing Address - Phone:303-749-0490
Mailing Address - Fax:720-536-4826
Practice Address - Street 1:11100 ASH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1732
Practice Address - Country:US
Practice Address - Phone:844-848-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-131813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132256OtherPK
KS912103004Medicaid