Provider Demographics
NPI:1316995186
Name:LEAVENWORTH VA CMOP
Entity type:Organization
Organization Name:LEAVENWORTH VA CMOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF CONSULTANT PBM/CMOP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEHR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPA
Authorized Official - Phone:913-758-4750
Mailing Address - Street 1:5000 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5581
Mailing Address - Country:US
Mailing Address - Phone:913-727-4860
Mailing Address - Fax:719-727-4851
Practice Address - Street 1:5000 13TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5581
Practice Address - Country:US
Practice Address - Phone:913-727-4860
Practice Address - Fax:719-727-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1718595OtherNCPDP#
KSBD4829062OtherDEA#