Provider Demographics
NPI:1790779460
Name:DEFEVER OSBORN DRUG
Entity Type:Organization
Organization Name:DEFEVER OSBORN DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-331-4200
Mailing Address - Street 1:205 N PENN AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3323
Mailing Address - Country:US
Mailing Address - Phone:620-331-4200
Mailing Address - Fax:620-331-8220
Practice Address - Street 1:205 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3323
Practice Address - Country:US
Practice Address - Phone:620-331-4200
Practice Address - Fax:620-331-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS209687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1306650001Medicare NSC