Provider Demographics
NPI:1598788960
Name:DIGHTON DRUG PARTNERSHIP
Entity Type:Organization
Organization Name:DIGHTON DRUG PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-397-5331
Mailing Address - Street 1:136 E LONG ST
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:DIGHTON
Mailing Address - State:KS
Mailing Address - Zip Code:67839-0548
Mailing Address - Country:US
Mailing Address - Phone:620-397-5331
Mailing Address - Fax:
Practice Address - Street 1:136 E LONG ST
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839-0548
Practice Address - Country:US
Practice Address - Phone:620-397-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-085203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100443650AMedicaid
KS5943620001Medicare NSC