Medical Pharmacy PA – Community/Retail Pharmacy

Key facts

NPI: 1104873769
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
License: 2-10232 (KS)
Legal business name: MEDICAL PHARMACY PA
Practice address: 1100 Columbine Dr
Holton, KS 66436-8841
Phone: (785) 364-2114
Fax: (785) 364-4501
NPI assigned: May 28, 2006
Organization subpart: No

Authorized official

Name: Joseph Gilliland NPI 1437030129
Title: Owner
Phone: (785) 364-2114

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Medical Pharmacy PA Durable Medical Equipment & Medical Supplies · Holton, KS · NPI 1679673982

Same PAC ID 7810196722

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Medical Pharmacy PA Long Term Care Pharmacy · Holton, KS · NPI 1073325700

NPD tax ID

Practitioners 1

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

Joseph P Gilliland, PHARM. D. Pharmacist · Holton, KS · NPI 1437030129

NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment: Enrolled in KS

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20231117001035	KS	Part B Supplier - Pharmacy	7810196722	Practice locations: Holton, KS

National Provider Directory

Tax ID family: Medical Pharmacy PA (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacy	333600000X
Community/Retail Pharmacy	3336C0003X	2-10232	KS	Yes

Addresses

Primary practice location

1100 Columbine Dr
Holton, KS 66436-8841

Mailing address

PO Box 9830
Salt Lake City, UT 84109-9830
Phone (877) 540-4748

Other identifiers

Identifier	Type	State	Issuer
2120416	Other		PK
200603920A	Medicaid	KS

Other names

MEDICAL PHARMACY PA Doing business as

Other providers in Holton, KS

All providers in Holton, KS · Community/Retail Pharmacy in Kansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.