Organization Active NPI

Seitz Pharmacy LLC

Doing business as Seitz Drug

  • Community/Retail Pharmacy
  • Ellsworth, KS
National Provider Identifier
1265546246
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2-102146 Issued in KS
Legal business name
SEITZ PHARMACY LLC
Doing business as
Seitz Drug
Practice address
206 N Douglas Ave
Ellsworth, KS 67439-3216
Phone
(785) 472-3212
Fax
(785) 472-5464
NPI assigned
Aug 18, 2006
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Dr. Kynan Gibson, PHARM.DNPI 1346595097
Title
Owner
Phone
(785) 827-4455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 2-102146 KS Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

206 N Douglas Ave
Ellsworth, KS 67439-3216

Mailing address

206 N Douglas Ave
Ellsworth, KS 67439-3216
Phone (785) 472-3212

Other identifiers 2

IdentifierTypeStateIssuer
201152290AMedicaidKS
2168702OtherPK

Other names 1

  • SEITZ DRUG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240327000142 KS Part B Supplier - Pharmacy 3577900489 Practice locations: Ellsworth, KS

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

206 N Douglas Ave
Ellsworth, KS 67439
Phone (785) 472-3212

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1265546246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N DOUGLAS AVE",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674393216",
            "telephone_number": "785-472-3212",
            "fax_number": "785-472-5464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N DOUGLAS AVE",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674393216",
            "telephone_number": "785-472-3212",
            "fax_number": "785-472-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEITZ PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "KYNAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-827-4455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "2-102146",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201152290A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168702",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEITZ DRUG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SEITZ DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellsworth, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.