MEDICARE: MS. KATHLEEN ANN MENGONI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4369	NM
2	183500000X	Pharmacist	12376	KS
3	183500000X	Pharmacist	2010028719	MO

General Provider Information

NPI Number	:	1821370008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN MENGONI RPH

Provider Business Mailing Address
First Line	:	12900 GRANT ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66213-4649
Country	:	US
Telephone Number	:	913-449-7805
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4038
Country	:	US
Telephone Number	:	913-621-7073
Fax Number	:	913-233-1364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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