Provider Demographics
NPI:1528434248
Name:PLEASANTON DRUG COMPANY
Entity type:Organization
Organization Name:PLEASANTON DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-980-1410
Mailing Address - Street 1:11240 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66075
Mailing Address - Country:US
Mailing Address - Phone:913-352-8500
Mailing Address - Fax:913-352-8520
Practice Address - Street 1:11240 TUCKER RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075-8402
Practice Address - Country:US
Practice Address - Phone:913-352-8500
Practice Address - Fax:913-352-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2131943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153602OtherPK
KS201124650AMedicaid