Provider Demographics
NPI:1679541585
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
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-684-7899
Mailing Address - Street 1:7111 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1090
Mailing Address - Country:US
Mailing Address - Phone:316-684-7899
Mailing Address - Fax:316-684-8221
Practice Address - Street 1:7111 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1090
Practice Address - Country:US
Practice Address - Phone:316-684-7899
Practice Address - Fax:316-684-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
KS2-130373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2032528OtherPK
KS100438950AMedicaid