Provider Demographics
NPI:1225124357
Name:STORMONT VAIL PHARMACY, LLC
Entity type:Organization
Organization Name:STORMONT VAIL PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENAGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-354-6000
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:CORPORATE FINANCE
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6000
Mailing Address - Fax:
Practice Address - Street 1:830 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2487
Practice Address - Country:US
Practice Address - Phone:785-235-8796
Practice Address - Fax:785-235-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-088503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100443290AMedicaid
1707441OtherNCPDP OR NABP NUMBER