Provider Demographics
NPI:1700395878
Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Other - Org Name:CAMBRIDGE RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-760-3318
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MAIL STOP 4040
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-2361
Mailing Address - Fax:913-588-2385
Practice Address - Street 1:3825 CAMBRIDGE ST
Practice Address - Street 2:STE 1333
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2883
Practice Address - Country:US
Practice Address - Phone:913-574-3100
Practice Address - Fax:913-574-3182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-21
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21038633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy