Provider Demographics
NPI:1265921506
Name:UNIVERSITY OF KANSAS HOSPITAL
Entity type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-2370
Mailing Address - Street 1:10710 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1206
Mailing Address - Country:US
Mailing Address - Phone:913-588-2361
Mailing Address - Fax:913-588-2385
Practice Address - Street 1:10710 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1206
Practice Address - Country:US
Practice Address - Phone:913-588-2361
Practice Address - Fax:913-588-2385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF KANSAS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-1056563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177499OtherPK