Organization
MATHIS DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN M. MATHIS R.PH. (PRESIDENT PHARMACIST-IN-CHARGE)
(620) 724-4313
Entity
Organization
Contact information
Practice address
400 W SAINT JOHN ST, GIRARD, KS 66743-1213
(620) 724-4313
(620) 724-6900
Mailing address
PO BOX 97, GIRARD, KS 66743-0097
(620) 724-8400
(620) 724-6900
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
206354
KS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100435000A
—
KS
Enumeration date
07/15/2006
Last updated
10/13/2020
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