Organization
IRWIN-POTTER DRUG-MEDICAL-LAB
Active
Other names
IRWIN-POTTER DRUG-MEDICAL-LAB
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BRUMMER BS PHARMACY (GENERAL PARTNER)
(620) 842-5119
Entity
Organization
Contact information
Practice address
202 W MAIN ST, ANTHONY, KS 67003-2728
(620) 842-5119
(620) 842-3184
Mailing address
PO BOX 107, ANTHONY, KS 67003-0107
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
99-5632
OK
3336C0003X
Community/Retail Pharmacy
Primary
2-06385
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100643260A
—
KS
05
—
100643260B
—
KS
01
—
1701398
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/18/2006
Last updated
06/15/2011
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