Provider Demographics
NPI:1316107162
Name:SENIOR RX CARE OF KANSAS LLC
Entity type:Organization
Organization Name:SENIOR RX CARE OF KANSAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-250-2920
Mailing Address - Street 1:121 SE 6TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66603-3508
Mailing Address - Country:US
Mailing Address - Phone:877-232-4601
Mailing Address - Fax:877-234-1412
Practice Address - Street 1:121 SE 6TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3508
Practice Address - Country:US
Practice Address - Phone:877-232-4601
Practice Address - Fax:877-234-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
KS2101883336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027876OtherPK
KS200554760AMedicaid