Provider Demographics
NPI:1144253378
Name:AD ASTRA PHARMACY LLC
Entity type:Organization
Organization Name:AD ASTRA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-776-1200
Mailing Address - Street 1:1860 CLAFLIN ROAD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-776-1200
Mailing Address - Fax:785-776-1115
Practice Address - Street 1:1860 CLAFLIN ROAD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3492
Practice Address - Country:US
Practice Address - Phone:785-776-1200
Practice Address - Fax:785-776-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100437570AMedicaid
KS100437570BOtherDME
1708443OtherNABP
0205080001Medicare ID - Type Unspecified