Provider Demographics
NPI:1932724481
Name:MT OREAD PHARMACY LLC
Entity Type:Organization
Organization Name:MT OREAD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:AXCELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-843-0111
Mailing Address - Street 1:3510 CLINTON PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2145
Mailing Address - Country:US
Mailing Address - Phone:785-843-0111
Mailing Address - Fax:
Practice Address - Street 1:6265 ROCK CHALK DRIVE
Practice Address - Street 2:LMH HEALTH WEST, SUITE 1401
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-843-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT OREAD PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy