Provider Demographics
NPI:1629071246
Name:KOECHNER PHARMACIES LLC
Entity Type:Organization
Organization Name:KOECHNER PHARMACIES LLC
Other - Org Name:KEX RX PHARMACY & HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-742-2125
Mailing Address - Street 1:101 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2306
Mailing Address - Country:US
Mailing Address - Phone:785-742-2125
Mailing Address - Fax:785-742-4551
Practice Address - Street 1:101 S 6TH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2306
Practice Address - Country:US
Practice Address - Phone:785-742-2125
Practice Address - Fax:785-742-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
KS2101013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027797OtherPK
KS200406430AMedicaid
KS200406430AMedicaid