Provider Demographics
NPI:1780774927
Name:HOFFMAN PHARMACY
Entity type:Organization
Organization Name:HOFFMAN PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-457-3611
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549-0130
Mailing Address - Country:US
Mailing Address - Phone:785-457-3611
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549-9836
Practice Address - Country:US
Practice Address - Phone:785-457-3611
Practice Address - Fax:785-457-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KS2-042193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100435530AMedicaid
2031273OtherPK
KS100435530AMedicaid