Provider Demographics
NPI:1114766839
Name:BLUE RAPIDS PHARMACY INC
Entity type:Organization
Organization Name:BLUE RAPIDS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-509-2169
Mailing Address - Street 1:17 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:BLUE RAPIDS
Mailing Address - State:KS
Mailing Address - Zip Code:66411-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:BLUE RAPIDS
Practice Address - State:KS
Practice Address - Zip Code:66411-1344
Practice Address - Country:US
Practice Address - Phone:785-363-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy