Provider Demographics
NPI:1588624365
Name:HANOVER PROFESSIONAL PHARMACY INC
Entity type:Organization
Organization Name:HANOVER PROFESSIONAL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMES
Authorized Official - Suffix:
Authorized Official - Credentials:BS ACCOUNTING
Authorized Official - Phone:785-548-5616
Mailing Address - Street 1:701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-1931
Mailing Address - Country:US
Mailing Address - Phone:785-336-6146
Mailing Address - Fax:785-336-6147
Practice Address - Street 1:701 MAIN ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-1931
Practice Address - Country:US
Practice Address - Phone:785-336-6146
Practice Address - Fax:785-336-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
KS2-085533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025274800Medicaid
KS30003924440001Medicaid
KS30003924440002Medicaid
2031988OtherPK
2031988OtherPK