Organization
STAFFORD COUNTY DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE FREEMAN (OWNER)
(620) 377-5633
Entity
Organization
Contact information
Practice address
329A N US HIGHWAY 281, ST JOHN, KS 67576-8309
(620) 377-5633
Mailing address
PO BOX 247, ST JOHN, KS 67576-0247
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201170370A
—
KS
Enumeration date
02/02/2021
Last updated
02/02/2021
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