# MINNEOLA PHARMACY II LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Minneola Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508324021
- **Authorized official:** DR. JAN R GRANADOS PHARMD, MPH (MANAGER/MEMBER)
- **Authorized official phone:** (620) 885-4544

## Contact information

- **Practice address:** 131 S. MAIN ST., MINNEOLA, KS 67865-0460
- **Practice address phone:** (620) 885-4544
- **Practice address fax:** (620) 885-4723
- **Mailing address:** PO BOX 460, MINNEOLA, KS 67865-0460
- **Mailing address phone:** (620) 885-4544
- **Mailing address fax:** (620) 885-4723

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/04/2019
- **Last updated:** 05/11/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1447353503 | NPI | KS |
| 05 | — | 201318470A | — | KS |