Provider Demographics
NPI:1730264227
Name:AUBURN PHARMACY, INC.
Entity type:Organization
Organization Name:AUBURN PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
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 1:259 W PARK RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1080
Mailing Address - Country:US
Mailing Address - Phone:913-837-5555
Mailing Address - Fax:913-837-5569
Practice Address - Street 1:6 S. METCALF
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-4116
Practice Address - Country:US
Practice Address - Phone:913-837-5555
Practice Address - Fax:913-837-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-06-11
Deactivation Date:2007-01-09
Deactivation Code:
Reactivation Date:2007-12-27
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
KS2-102113336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100439770EMedicaid
MO1730264227Medicaid
KS100439770FMedicaid