Basic Information
| Provider Information | |||||||||
| NPI: | 1992450878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STORMONT-VAIL, INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2252 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666043965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852358796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2252 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666043965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852358796 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2022 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | STONE | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7853545623 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | Y | Suppliers | Pharmacy | Specialty Pharmacy |
No ID Information.