Provider Demographics
NPI:1104821040
Name:KRIEN PHARMACY INC
Entity type:Organization
Organization Name:KRIEN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC PHCST
Authorized Official - Prefix:
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:785-332-2177
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-0664
Mailing Address - Country:US
Mailing Address - Phone:785-332-2177
Mailing Address - Fax:
Practice Address - Street 1:105 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-5678
Practice Address - Country:US
Practice Address - Phone:785-332-2177
Practice Address - Fax:785-332-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
KS2097693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031215OtherPK
KS1104821040Medicaid
KS1104821040Medicaid