Provider Demographics
NPI:1760153936
Name:ROCKERS PHARMACY
Entity Type:Organization
Organization Name:ROCKERS PHARMACY
Other - Org Name:ROCKERS PHARMACY - LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:913-294-2715
Mailing Address - Street 1:304 BAPTISTE DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1327
Mailing Address - Country:US
Mailing Address - Phone:913-294-2715
Mailing Address - Fax:913-294-3666
Practice Address - Street 1:304 BAPTISTE DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1327
Practice Address - Country:US
Practice Address - Phone:913-294-2715
Practice Address - Fax:913-294-3666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKERS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613730AMedicaid