Provider Demographics
NPI:1699836866
Name:VOLLERTSEN-OBERLIN INC
Entity Type:Organization
Organization Name:VOLLERTSEN-OBERLIN INC
Other - Org Name:WARD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VOLLERTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-475-2285
Mailing Address - Street 1:142 S PENN AVE
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2243
Mailing Address - Country:US
Mailing Address - Phone:785-475-2285
Mailing Address - Fax:785-470-2470
Practice Address - Street 1:142 S PENN AVE
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2243
Practice Address - Country:US
Practice Address - Phone:785-475-2285
Practice Address - Fax:785-470-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS84193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100440200BMedicaid
KS100440200AMedicaid
KS1188250001Medicare ID - Type Unspecified