Organization
WYCLIFF PHARMACY INC
Active
Organization
WYCLIFF PHARMACY INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
10410 MASTIN ST, OVERLAND PARK, KS 66212-5701
(913) 492-4998
(913) 492-5121
Mailing address
10410 MASTIN ST, OVERLAND PARK, KS 66212-5701
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
208444
KS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1708277
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/31/2006
Last updated
03/07/2023
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