Provider Demographics
NPI:1609971670
Name:STOCKTON PHARMACY, INC.
Entity Type:Organization
Organization Name:STOCKTON PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-425-7172
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-1930
Mailing Address - Country:US
Mailing Address - Phone:785-425-7172
Mailing Address - Fax:785-425-6611
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:KS
Practice Address - Zip Code:67669-1930
Practice Address - Country:US
Practice Address - Phone:785-425-7172
Practice Address - Fax:785-425-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS090383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1705346OtherNABP NUMBER