Organization
PRESCRIPTION SHOP, INC
Active
Other names
PRESCRIPTION SHOP INC
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN DEFEVER RPH (OWNER)
(913) 515-0462
Entity
Organization
Contact information
Practice address
601 W 11TH ST, COFFEYVILLE, KS 67337-5025
(620) 251-1620
(620) 251-4730
Mailing address
601 W 11TH ST, COFFEYVILLE, KS 67337-5025
(620) 251-1620
(620) 251-4730
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
209131
KS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100434720A
—
KS
05
—
100434720B
—
KS
01
—
2030507
PK
—
Enumeration date
10/17/2005
Last updated
04/11/2016
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