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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