Provider Demographics
NPI:1790903599
Name:KEVIN L KRILEY
Entity Type:Organization
Organization Name:KEVIN L KRILEY
Other - Org Name:KRILEYS FAMILY DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-282-6280
Mailing Address - Street 1:125 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-2605
Mailing Address - Country:US
Mailing Address - Phone:785-282-6843
Mailing Address - Fax:785-282-6844
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-2605
Practice Address - Country:US
Practice Address - Phone:785-282-6843
Practice Address - Fax:785-282-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
KS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100329390CMedicaid
KS100329390CMedicaid