| NAME |
LEAVENWORTH PHARMACY |
| STATE |
KANSAS |
| STREET ADDR. 1 |
4101 S 4TH ST |
| CITY |
LEAVENWORTH |
| ZIP |
66048-5014 |
| OFFICIAL VA NAME |
Leavenworth Pharmacy |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
LEAVENWORTH VAMC PHARMACY |
| ST. ADDR. 1 (MAILING) |
4101 S 4TH ST |
| CITY (MAILING) |
LEAVENWORTH |
| STATE (MAILING) |
KANSAS |
| ZIP (MAILING) |
66048-5014 |
| EFFECTIVE DATE/TIME |
-
- 2006-08-22 00:00:00
- STATUS: ACTIVE
- NPI: 1295793032
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 4101 SOUTH 4TH ST
- CITY (CHANGED FROM): LEAVENWORTH
- STATE (CHANGED FROM): KANSAS
- ZIP (CHANGED FROM): 66048-5014
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1295793032
|
