Organization
IOLA PHARMACY INC
Active
Other names
GERICARE LTC
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM WALDEN RPH (SECRETARY)
(620) 365-5555
Entity
Organization
Contact information
Practice address
113 E MADISON AVE, IOLA, KS 66749-3330
(620) 365-5555
(620) 365-6722
Mailing address
109 E MADISON AVE, IOLA, KS 66749-3330
(620) 365-5555
(620) 365-6722
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
209923
KS
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259940A
—
KS
01
—
2027270
PK
—
Enumeration date
08/18/2006
Last updated
01/19/2017
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