Organization
MEDICINE STORE LLC
Active
Other names
THE MEDICINE STORE
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI TAYLOR BS PHARM (MANAGER/PHARMACIST IN CHARGE)
(913) 369-2100
Entity
Organization
Contact information
Practice address
760 NORTHSTAR CT, TONGANOXIE, KS 66086-8933
(913) 369-2100
(913) 369-2101
Mailing address
PO BOX 580, TONGANOXIE, KS 66086-0580
(913) 369-2100
(913) 369-2101
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-10213
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200574500C
—
KS
05
—
200574500D
—
KS
01
—
2025539
PK
—
Enumeration date
07/02/2006
Last updated
06/29/2016
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