Provider Demographics
NPI:1942394010
Name:AUBURN PHARMACY OSAGE, LLC.
Entity Type:Organization
Organization Name:AUBURN PHARMACY OSAGE, LLC.
Other - Org Name:AUBURN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:259 W PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1080
Mailing Address - Country:US
Mailing Address - Phone:785-528-4415
Mailing Address - Fax:785-528-4930
Practice Address - Street 1:890 LAKIN ST
Practice Address - Street 2:
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-1152
Practice Address - Country:US
Practice Address - Phone:785-528-4415
Practice Address - Fax:785-528-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
KS2132433336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200259250BMedicaid
KS200259250AMedicaid
2031138OtherPK