Provider Demographics
NPI:1205948155
Name:SABETHA PHARMACY INC
Entity type:Organization
Organization Name:SABETHA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-284-3414
Mailing Address - Street 1:934 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-1829
Mailing Address - Country:US
Mailing Address - Phone:785-284-3414
Mailing Address - Fax:785-284-3040
Practice Address - Street 1:934 MAIN ST
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534-1829
Practice Address - Country:US
Practice Address - Phone:785-284-3414
Practice Address - Fax:785-284-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026225OtherPK
KS100440190AMedicaid
2026225OtherPK