Provider Demographics
NPI:1124111034
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:913-294-3516
Mailing Address - Fax:913-294-8411
Practice Address - Street 1:311 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1303
Practice Address - Country:US
Practice Address - Phone:913-294-3516
Practice Address - Fax:913-294-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025308332B00000X
333600000X, 3336C0004X
KS2-090443336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201174430OMedicaid
KS201174430RMedicaid
KS100436130AMedicaid
KS100436140AMedicaid