Provider Demographics
NPI:1679685523
Name:RICHEYS REXALL DRUG INC
Entity Type:Organization
Organization Name:RICHEYS REXALL DRUG INC
Other - Org Name:RICHEYS REXALL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNERS
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-244-3311
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:KS
Mailing Address - Zip Code:66733-0195
Mailing Address - Country:US
Mailing Address - Phone:620-244-3661
Mailing Address - Fax:620-244-5487
Practice Address - Street 1:511 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:KS
Practice Address - Zip Code:66733-1017
Practice Address - Country:US
Practice Address - Phone:620-244-3661
Practice Address - Fax:620-244-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2-102513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025982OtherPK
KS100439940Medicaid
0549440001Medicare NSC