Organization
MEDICAL PARK PHARMACY OF GREAT BEND PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN LAVERN REGIER RPH (RPH PRESIDENT)
(620) 792-1221
Entity
Organization
Contact information
Practice address
1309 POLK, GREAT BEND, KS 67530-3644
(620) 792-1221
(620) 792-6413
Mailing address
1309 POLK, GREAT BEND, KS 67530-3644
(620) 792-1221
(620) 792-6413
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100444470A
—
KS
05
—
100444470B
—
KS
Enumeration date
11/15/2006
Last updated
02/20/2020
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