Provider Demographics
NPI:1871115394
Name:ANDERSON-ROGERS PHARMACY LLC
Entity type:Organization
Organization Name:ANDERSON-ROGERS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:785-843-8555
Mailing Address - Street 1:8829 ASHBLOOM LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-1455
Mailing Address - Country:US
Mailing Address - Phone:620-506-1330
Mailing Address - Fax:
Practice Address - Street 1:1410 KASOLD DR STE A16
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3428
Practice Address - Country:US
Practice Address - Phone:785-843-8555
Practice Address - Fax:785-843-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201283480AMedicaid