Provider Demographics
NPI:1760592000
Name:LEEKERS FAMILY FOODS INC
Entity Type:Organization
Organization Name:LEEKERS FAMILY FOODS INC
Other - Org Name:LEEKERS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:316-744-3948
Mailing Address - Street 1:6223 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1101
Mailing Address - Country:US
Mailing Address - Phone:316-744-3948
Mailing Address - Fax:316-744-9801
Practice Address - Street 1:6223 N BROADWAY
Practice Address - Street 2:LEEKERS FAMILY PHARMACY
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-1194
Practice Address - Country:US
Practice Address - Phone:316-744-3948
Practice Address - Fax:316-744-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2087593336C0003X
KS2-132053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100438780AMedicaid