Provider Demographics
NPI:1285714709
Name:ALDRICH APOTHECARY CHARTERED
Entity type:Organization
Organization Name:ALDRICH APOTHECARY CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-767-6731
Mailing Address - Street 1:115 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1702
Mailing Address - Country:US
Mailing Address - Phone:316-767-6800
Mailing Address - Fax:620-767-6858
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1702
Practice Address - Country:US
Practice Address - Phone:620-767-6731
Practice Address - Fax:620-767-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-076473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030744OtherPK
KS100443780BMedicaid
KS100443780AMedicaid