Provider Demographics
NPI:1780795468
Name:AUTEN PHARMACY, INC.
Entity type:Organization
Organization Name:AUTEN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-755-4111
Mailing Address - Street 1:125 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1125
Mailing Address - Country:US
Mailing Address - Phone:913-755-4111
Mailing Address - Fax:913-755-2867
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1125
Practice Address - Country:US
Practice Address - Phone:913-755-4111
Practice Address - Fax:913-755-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-07953332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439820BMedicaid
KS100439820BMedicaid
KSKA1486Medicare PIN