Provider Demographics
NPI:1619168374
Name:FAMILY PRESCRIPTION SHOP INC
Entity Type:Organization
Organization Name:FAMILY PRESCRIPTION SHOP INC
Other - Org Name:HART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:316-295-4721
Mailing Address - Street 1:1919 N AMIDON
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203
Mailing Address - Country:US
Mailing Address - Phone:316-295-4721
Mailing Address - Fax:316-295-4724
Practice Address - Street 1:1919 N AMIDON
Practice Address - Street 2:SUITE 220
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:US
Practice Address - Phone:316-295-4721
Practice Address - Fax:316-295-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336S0011X
KS2-130363336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027812OtherPK