Provider Demographics
NPI:1588761696
Name:BOYAJIAN INC
Entity type:Organization
Organization Name:BOYAJIAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-856-8106
Mailing Address - Street 1:131 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1309
Mailing Address - Country:US
Mailing Address - Phone:913-856-8106
Mailing Address - Fax:913-856-8802
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1309
Practice Address - Country:US
Practice Address - Phone:913-856-8106
Practice Address - Fax:913-856-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02-9108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100443770AMedicaid
KS100443770BMedicaid
KS1199310001Medicare NSC
KS1199310001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
KS9004149Medicare PIN