Organization
AV DRUG ACQUISITION CO
Active
Other names
GREAT PLAINS COMPOUNDING CTR
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP F RELLIHAN RPH (GENERAL MANAGER)
(913) 234-4664
Entity
Organization
Contact information
Practice address
11131 W 79TH ST, LENEXA, KS 66214-1482
(913) 234-4664
(913) 234-4665
Mailing address
11131 W 79TH ST, LENEXA, KS 66214-1482
(913) 234-4664
(913) 234-4665
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
209463
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100434000A
—
KS
01
—
1715260
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/04/2006
Last updated
04/20/2012
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