Glen M Mathis, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

206354 Issued in KS

Practice address

400 W Saint John St
Girard, KS 66743-1213

Phone

(620) 724-4313

Fax

(620) 724-6900

NPI assigned

Jul 19, 2006

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Karen Mathis Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mathis Drug Store, Inc.

  • Community/Retail Pharmacy
  • Girard, KS
  • NPI 1861418444
  NPD Authorized official

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1942229679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "last_name": "MATHIS",
        "first_name": "GLEN",
        "middle_name": "M",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KS",
            "license": "206354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100435000A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "MATHIS",
            "credential": "PHARMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Learning Tree Institute (Audiology Clinic-Learning Tree Institute at Greenbush)
• Ceri Loflin, AUD
• Mathis Drug Store, Inc.
• Mathis Drugs Inc (Mathis Drugs)
• Mathis Drugs Inc (Mathis Drugs)
• Karen Sue Mathis, PHARMD
• Sandra R McChristy, APRN
• Medicalodges, Inc. (Medicalodges Girard)
• Brandon M Mork
• Jeannie M Napier

• Pharmacist in Girard, KS
• Providers in Girard, KS by specialty
• Pharmacist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.