Provider Demographics
NPI:1710934369
Name:QUALICARE INC
Entity Type:Organization
Organization Name:QUALICARE INC
Other - Org Name:QUALICARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLITS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-841-1950
Mailing Address - Street 1:2336 RIDGE CT
Mailing Address - Street 2:STE C
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3983
Mailing Address - Country:US
Mailing Address - Phone:785-841-1950
Mailing Address - Fax:785-841-1051
Practice Address - Street 1:2336 RIDGE CT
Practice Address - Street 2:STE C
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3983
Practice Address - Country:US
Practice Address - Phone:785-841-1950
Practice Address - Fax:785-841-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-08151332B00000X
MO2014021802333600000X
3336C0004X, 3336H0001X
AZY0074663336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100441500AMedicaid
KS100441500BMedicaid
MO1710934369Medicaid
2026128OtherPK