Provider Demographics
NPI:1760594618
Name:ORCHARDS DRUG LC
Entity Type:Organization
Organization Name:ORCHARDS DRUG LC
Other - Org Name:ORCHARDS DRUG LC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:785-843-8555
Mailing Address - Street 1:1410 KASOLD DR
Mailing Address - Street 2:STE A16
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3424
Mailing Address - Country:US
Mailing Address - Phone:785-843-8555
Mailing Address - Fax:785-843-0645
Practice Address - Street 1:1410 KASOLD DR
Practice Address - Street 2:STE A16
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3424
Practice Address - Country:US
Practice Address - Phone:785-843-8555
Practice Address - Fax:785-843-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
KS2-077453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025806OtherPK
KS100439380AMedicaid