Kurt William Vollertsen
Individual provider Active NPI Pharmacist · Oberlin, KS
NPI 1124110960 · NPPES record last updated Mar 11, 2013
Key facts
- NPI
- 1124110960
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10195 (KS)
- Practice address
- 142 S Penn Ave
Oberlin, KS 67749-2243 - Phone
- (785) 475-2285
- Fax
- (785) 470-2470
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10195 | KS | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10195 | KS | Yes |
Addresses
Primary practice location
142 S Penn Ave
Oberlin, KS 67749-2243
Mailing address
142 S Penn Ave
Oberlin, KS 67749-2243
Phone (785) 475-2285
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100440200B | Medicaid | KS | |
| 100440200A | Medicaid | KS |
Other providers in Oberlin, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.