Provider Demographics
NPI:1679643480
Name:KINGMAN DRUG INC
Entity Type:Organization
Organization Name:KINGMAN DRUG INC
Other - Org Name:CHENEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-532-5113
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-0511
Mailing Address - Country:US
Mailing Address - Phone:316-542-0464
Mailing Address - Fax:316-542-0527
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025-8606
Practice Address - Country:US
Practice Address - Phone:316-542-0464
Practice Address - Fax:316-542-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
KS2-099903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080410BMedicaid
2026579OtherPK
0319330003Medicare NSC