Provider Demographics
NPI:1710205422
Name:CARDINAL PHARMACY LLC
Entity Type:Organization
Organization Name:CARDINAL PHARMACY LLC
Other - Org Name:CARDINAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-653-2200
Mailing Address - Street 1:821 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1842
Mailing Address - Country:US
Mailing Address - Phone:620-653-2200
Mailing Address - Fax:620-653-7386
Practice Address - Street 1:821 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1842
Practice Address - Country:US
Practice Address - Phone:620-653-2200
Practice Address - Fax:620-653-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-102943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720134OtherNCPDP PROVIDER IDENTIFICATION NUMBER