Provider Demographics
NPI:1609001395
Name:NEIGHBORHOOD PHARMACY
Entity Type:Organization
Organization Name:NEIGHBORHOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBUBE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUONYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-665-4427
Mailing Address - Street 1:NEIGHBORHOOD PHARMACY
Mailing Address - Street 2:P.O. BOX 685
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201
Mailing Address - Country:US
Mailing Address - Phone:316-665-4427
Mailing Address - Fax:888-252-7110
Practice Address - Street 1:2251 E 21ST ST N
Practice Address - Street 2:SUITE 121
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-1972
Practice Address - Country:US
Practice Address - Phone:316-665-4427
Practice Address - Fax:888-252-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-103263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200607440AMedicaid
2120409OtherPK