Provider Demographics
NPI:1861591463
Name:GREENSBURG DRUG CO INC
Entity type:Organization
Organization Name:GREENSBURG DRUG CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-659-2136
Mailing Address - Street 1:207 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-1109
Mailing Address - Country:US
Mailing Address - Phone:620-659-2136
Mailing Address - Fax:620-659-2252
Practice Address - Street 1:207 E 6TH ST
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-1109
Practice Address - Country:US
Practice Address - Phone:620-659-2136
Practice Address - Fax:620-659-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2-089143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100437590AMedicaid
2031053OtherPK