Provider Demographics
NPI:1801964606
Name:CANEY PHARMACY INC
Entity type:Organization
Organization Name:CANEY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-879-5822
Mailing Address - Street 1:208 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-1462
Mailing Address - Country:US
Mailing Address - Phone:620-879-5822
Mailing Address - Fax:620-879-2721
Practice Address - Street 1:208 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1462
Practice Address - Country:US
Practice Address - Phone:620-879-5822
Practice Address - Fax:620-879-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155967OtherPK
KS100439890BMedicaid
OK100846330AMedicaid
0272540001Medicare NSC