Provider Demographics
NPI:1386320885
Name:MT OREAD PHARMACY LLC
Entity type:Organization
Organization Name:MT OREAD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:AXCELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-843-0111
Mailing Address - Street 1:6265 ROCK CHALK DR STE 1401
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5232
Mailing Address - Country:US
Mailing Address - Phone:785-843-0455
Mailing Address - Fax:785-424-7375
Practice Address - Street 1:6265 ROCK CHALK DR STE 1401
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-843-0455
Practice Address - Fax:785-424-7375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT. OREAD PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy