Provider Demographics
NPI:1730298878
Name:SUNSET PLAZA DRUG CORPORATION
Entity Type:Organization
Organization Name:SUNSET PLAZA DRUG CORPORATION
Other - Org Name:KEY REXALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-827-0408
Mailing Address - Street 1:901 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5100
Mailing Address - Country:US
Mailing Address - Phone:785-827-0408
Mailing Address - Fax:785-827-8371
Practice Address - Street 1:901 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5100
Practice Address - Country:US
Practice Address - Phone:785-827-0408
Practice Address - Fax:785-827-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-100903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100436120AMedicaid
KS100434590AMedicaid
KS1705055OtherNCPDP
KS100434590AMedicaid