Organization
ROBERTS PBA DRUG STORE
Active
Organization
ROBERTS PBA DRUG STORE
Active
Other names
ROBERTS PBA DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ROBERTS (OWNER)
(785) 594-6711
Entity
Organization
Contact information
Practice address
112 8TH ST, BALDWIN CITY, KS 66006-4149
(785) 594-6867
(785) 594-3883
Mailing address
PO BOX 71, BALDWIN CITY, KS 66006-0071
(785) 594-6711
(785) 594-3883
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
209755
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100443660A
—
KS
01
—
2030679
PK
—
Enumeration date
08/31/2006
Last updated
12/06/2016
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