Provider Demographics
NPI:1699241984
Name:AUBURN PHARMACY, INC.
Entity type:Organization
Organization Name:AUBURN PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-448-3600
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-0388
Mailing Address - Country:US
Mailing Address - Phone:785-243-1212
Mailing Address - Fax:785-243-1213
Practice Address - Street 1:1526 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-4830
Practice Address - Country:US
Practice Address - Phone:785-243-1212
Practice Address - Fax:785-243-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201174430KMedicaid
KS100439770SMedicaid