Provider Demographics
NPI:1255756003
Name:KEX RX FALLS CITY LLC
Entity type:Organization
Organization Name:KEX RX FALLS CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,RPH,AO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-742-2125
Mailing Address - Street 1:101 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2306
Mailing Address - Country:US
Mailing Address - Phone:785-742-2125
Mailing Address - Fax:785-742-4551
Practice Address - Street 1:120 E 18TH ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2116
Practice Address - Country:US
Practice Address - Phone:402-245-2029
Practice Address - Fax:800-558-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NE30123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146319OtherPK
NE100264047-00Medicaid