Provider Demographics
NPI:1679972624
Name:DEGOLER'S INC.
Entity Type:Organization
Organization Name:DEGOLER'S INC.
Other - Org Name:DEGOLER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-2447
Mailing Address - Street 1:19601 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-8600
Mailing Address - Country:US
Mailing Address - Phone:913-764-9005
Mailing Address - Fax:
Practice Address - Street 1:19601 W 101ST ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-8600
Practice Address - Country:US
Practice Address - Phone:913-764-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-130443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146997OtherPK