Provider Demographics
NPI:1568691939
Name:KANSAS PALLIATIVE PHARMACY, LLC
Entity Type:Organization
Organization Name:KANSAS PALLIATIVE PHARMACY, LLC
Other - Org Name:KANSAS PALLIATIVE PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-268-9441
Mailing Address - Street 1:313 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202
Mailing Address - Country:US
Mailing Address - Phone:316-265-9441
Mailing Address - Fax:316-265-8657
Practice Address - Street 1:313 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3805
Practice Address - Country:US
Practice Address - Phone:316-265-9441
Practice Address - Fax:316-265-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2-094053336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120851OtherPK
171500Medicare Oscar/Certification
171500Medicare Oscar/Certification