Basic Information
| Provider Information | |||||||||
| NPI: | 1518064039 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTERNACARE INFUSION PHARMACY INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMERITA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6912 S QUENTIN ST STE 50 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202825325 | ||||||||
| FaxNumber: | 8773025251 | ||||||||
| Practice Location | |||||||||
| Address1: | 15303 W 95TH ST BLDG 5A | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662191262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139069260 | ||||||||
| FaxNumber: | 9139069321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | IRIYE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7202822377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | 2-13214 | KS | N | Suppliers | Pharmacy | Specialty Pharmacy | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 3336C0004X | 2-13214 | KS | N | Suppliers | Pharmacy | Compounding Pharmacy | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336H0001X | 2-13214 | KS | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 607934502 | 05 | MO | MEDICAID | 100080250B | 05 | KS | MEDICAID |