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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