Provider Demographics
NPI:1457335036
Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
Other - Org Name:UNIVERSITY OF KANSAS HOSPITAL RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-588-7332
Mailing Address - Street 1:PO BOX 955772
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5772
Mailing Address - Country:US
Mailing Address - Phone:913-588-2371
Mailing Address - Fax:913-588-2385
Practice Address - Street 1:4000 CAMBRIDGE STREET MAILSTOP 4040
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-2371
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:2005-12-06
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2043453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031345OtherPK
MO600567804Medicaid
KS100319330BMedicaid
KS100319330DMedicaid
KS100319330DMedicaid