Mathis Drug Store, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

206354 Issued in KS

Legal business name

MATHIS DRUG STORE, INC.

Practice address

400 W Saint John St
Girard, KS 66743-1213

Phone

(620) 724-4313

Fax

(620) 724-6900

NPI assigned

Jul 15, 2006

Last updated

Oct 13, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glen M. Mathis, R.PH.NPI 1942229679

Title

President Pharmacist-in-Charge

Phone

(620) 724-4313

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 1

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.

• Glen M Mathis, RPH

  • Pharmacist
  • Girard, KS
  • NPI 1942229679
  NPD Authorized official

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1861418444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "GIRARD",
            "state": "KS",
            "postal_code": "667430097",
            "telephone_number": "620-724-8400",
            "fax_number": "620-724-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W SAINT JOHN ST",
            "city": "GIRARD",
            "state": "KS",
            "postal_code": "667431213",
            "telephone_number": "620-724-4313",
            "fax_number": "620-724-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATHIS DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "620-724-4313",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "206354",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100435000A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret A Kramer, MA, RD, LD
• Patrick Lackamp, LAC
• Chandroutie Latchman, D.O
• Learning Tree Institute (Audiology Clinic-Learning Tree Institute at Greenbush)
• Ceri Loflin, AUD
• Mathis Drugs Inc (Mathis Drugs)
• Mathis Drugs Inc (Mathis Drugs)
• Glen M Mathis, RPH
• Karen Sue Mathis, PHARMD
• Sandra R McChristy, APRN

• Community/Retail Pharmacy in Girard, KS
• Providers in Girard, KS by specialty
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.