Provider Demographics
NPI:1104900364
Name:AUBURN PHARMACY INC
Entity type:Organization
Organization Name:AUBURN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:259 W PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1080
Mailing Address - Country:US
Mailing Address - Phone:785-448-3600
Mailing Address - Fax:785-448-3600
Practice Address - Street 1:606 E MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-9100
Practice Address - Country:US
Practice Address - Phone:417-466-2000
Practice Address - Fax:417-466-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2024-06-10
Deactivation Date:2007-01-09
Deactivation Code:
Reactivation Date:2007-04-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048663OtherPK
MO601917503Medicaid
2048663OtherPK