Organization
STAFFORD COUNTY DRUG
Active
Other names
Stafford County Drug
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE FREEMAN (CO-OWNER)
(620) 886-5161
Entity
Organization
Contact information
Practice address
329A N US HIGHWAY 281, ST JOHN, KS 67576-8309
(620) 377-5633
(620) 377-5656
Mailing address
PO BOX 247, ST JOHN, KS 67576-0247
(620) 377-5633
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-103986
KS
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2171587
PK
—
Enumeration date
09/25/2017
Last updated
02/17/2021
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