Provider Demographics
NPI:1871527192
Name:GRAVES DRUG STORE EMPORIA INC
Entity type:Organization
Organization Name:GRAVES DRUG STORE EMPORIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOLLHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:620-343-2323
Mailing Address - Street 1:609 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3901
Mailing Address - Country:US
Mailing Address - Phone:620-343-2323
Mailing Address - Fax:620-343-2663
Practice Address - Street 1:609 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-3901
Practice Address - Country:US
Practice Address - Phone:620-343-2323
Practice Address - Fax:620-343-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-080353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0210950001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #