Provider Demographics
NPI:1457446437
Name:DEGOLERS INC
Entity type:Organization
Organization Name:DEGOLERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-596-2447
Mailing Address - Street 1:111 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-1049
Mailing Address - Country:US
Mailing Address - Phone:913-422-3066
Mailing Address - Fax:913-422-7050
Practice Address - Street 1:202 OAK ST
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-1029
Practice Address - Country:US
Practice Address - Phone:913-422-3066
Practice Address - Fax:913-422-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-103513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131783OtherPK
KS100435330HMedicaid