Provider Demographics
NPI:1821038373
Name:RX ADEL INC
Entity Type:Organization
Organization Name:RX ADEL INC
Other - Org Name:MEDICINE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SANOSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-764-1800
Mailing Address - Street 1:539 E SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3419
Mailing Address - Country:US
Mailing Address - Phone:913-764-1800
Mailing Address - Fax:913-764-9127
Practice Address - Street 1:539 E SANTA FE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3419
Practice Address - Country:US
Practice Address - Phone:913-764-1800
Practice Address - Fax:913-764-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS209192183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080580AMedicaid
0420440002Medicare NSC