# IOLA PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GERICARE LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255445235
- **Authorized official:** WILLIAM WALDEN RPH (SECRETARY)
- **Authorized official phone:** (620) 365-5555

## Contact information

- **Practice address:** 113 E MADISON AVE, IOLA, KS 66749-3330
- **Practice address phone:** (620) 365-5555
- **Practice address fax:** (620) 365-6722
- **Mailing address:** 109 E MADISON AVE, IOLA, KS 66749-3330
- **Mailing address phone:** (620) 365-5555
- **Mailing address fax:** (620) 365-6722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 209923 | KS | Yes |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 01/19/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200259940A | — | KS |
| 01 | — | 2027270 | PK | — |