NPIMap

Organization Active NPI

Mt Oread Pharmacy LLC

  • Pharmacy
  • Lawrence, KS
National Provider Identifier
1083834998
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MT OREAD PHARMACY LLC
Doing business as
Jayhawk Pharmacy
Practice address
3510 Clinton Parkway Place
Suite 220
Lawrence, KS 66047-2195
Phone
(785) 843-0111
Fax
(785) 843-3818
NPI assigned
Apr 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Erick W Axcell, PHARMD
Title
Pharmacist
Phone
(785) 843-0111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 08834 KS
Pharmacy 333600000X Primary

Addresses

Primary practice location

3510 Clinton Parkway Place
Suite 220
Lawrence, KS 66047-2195

Mailing address

3510 Clinton Parkway Place
Suite 220
Lawrence, KS 66047-2195
Phone (785) 843-0111

Other identifiers 1

IdentifierTypeStateIssuer
100432770AMedicaidKS

Other names 1

  • Jayhawk Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200122000114 KS Part B Supplier - Mass Immunization (Roster Biller Only) 2961522651 1 other NPI on this enrollment
Practice locations: Lawrence, KS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3510 Clinton Pl
Ste 220
Lawrence, KS 66047
Phone (785) 843-0111

3510 Clinton Pkwy
Ste 220
Lawrence, KS 66047
Phone (785) 843-0111

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1083834998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 CLINTON PARKWAY PLACE",
            "address_2": "SUITE 220",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660472195",
            "telephone_number": "785-843-0111",
            "fax_number": "785-843-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 CLINTON PARKWAY PLACE",
            "address_2": "SUITE 220",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660472195",
            "telephone_number": "785-843-0111",
            "fax_number": "785-843-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT OREAD PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "AXCELL",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "785-843-0111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "KS",
            "license": "08834",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100432770A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jayhawk Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jayhawk Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.