Organization
MINNEOLA PHARMACY II LLC
Active
Other names
Minneola Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN R GRANADOS PHARMD, MPH (MANAGER/MEMBER)
(620) 885-4544
Entity
Organization
Contact information
Practice address
131 S. MAIN ST., MINNEOLA, KS 67865-0460
(620) 885-4544
(620) 885-4723
Mailing address
PO BOX 460, MINNEOLA, KS 67865-0460
(620) 885-4544
(620) 885-4723
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447353503
NPI
KS
05
—
201318470A
—
KS
Enumeration date
03/04/2019
Last updated
05/11/2021
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