Provider Demographics
NPI:1942474135
Name:PINNACLE PHARMACY GROUP, INC.
Entity Type:Organization
Organization Name:PINNACLE PHARMACY GROUP, INC.
Other - Org Name:COMPREHENSIVE HEALTH SERVICES (CHS PHARMACY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-259-9234
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0782
Mailing Address - Country:US
Mailing Address - Phone:620-855-2055
Mailing Address - Fax:620-855-2052
Practice Address - Street 1:202 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835
Practice Address - Country:US
Practice Address - Phone:620-855-2055
Practice Address - Fax:620-855-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2-130203336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027873OtherPK
KS201270990AMedicaid