Organization
MEDICAL PHARMACY PA
Active
Other names
MEDICAL PHARMACY PA
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GILLILAND (OWNER)
(785) 364-2114
Entity
Organization
Contact information
Practice address
1100 COLUMBINE DR, HOLTON, KS 66436-8841
(785) 364-2114
(785) 364-4501
Mailing address
PO BOX 9830, SALT LAKE CITY, UT 84109-9830
(877) 540-4748
(801) 716-4824
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-10232
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200603920A
—
KS
01
—
2120416
PK
—
Enumeration date
05/28/2006
Last updated
06/29/2016
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