Provider Demographics
NPI:1649379538
Name:RICKS PHARMACY AND WELLNESS INC
Entity Type:Organization
Organization Name:RICKS PHARMACY AND WELLNESS INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:316-838-2100
Mailing Address - Street 1:2315 W 21ST ST N
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2315 W 21ST ST N
Practice Address - Street 2:SUITE 117
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2150
Practice Address - Country:US
Practice Address - Phone:316-838-2100
Practice Address - Fax:316-838-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2100433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1715359OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KS100440100BMedicaid
0799740001Medicare NSC