Provider Demographics
NPI:1790158673
Name:KUEKER FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:KUEKER FAMILY PHARMACY LLC
Other - Org Name:HESSTON PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST/OWNER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KUEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-327-2211
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-8940
Mailing Address - Country:US
Mailing Address - Phone:620-327-2211
Mailing Address - Fax:620-327-2500
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-8940
Practice Address - Country:US
Practice Address - Phone:620-327-2211
Practice Address - Fax:620-327-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-13210333600000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7548250001Medicare NSC