| NPI | 1144321084 |
|---|---|
| Other Name | BROADWAY PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DAVID B BERGEN President / Pharmacist 316-260-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: KS 209952) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2015-06-25 |