Provider Demographics
NPI:1063573178
Name:JEFFREY L MENZIE
Entity type:Organization
Organization Name:JEFFREY L MENZIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-356-1446
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-0925
Mailing Address - Country:US
Mailing Address - Phone:620-356-1446
Mailing Address - Fax:620-356-5381
Practice Address - Street 1:219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2130
Practice Address - Country:US
Practice Address - Phone:620-356-1446
Practice Address - Fax:620-356-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
KS2067953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1705702OtherNCPDP PROVIDER IDENTIFICATION NUMBER