Healthcare Provider Details

I. General information

NPI: 1326035668
Provider Name (Legal Business Name): MARY KATHLEEN JANCICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COMMERCIAL ST
ATCHISON KS
66002-2434
US

IV. Provider business mailing address

PO BOX 91
TROY KS
66087-0091
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-4113
  • Fax: 913-367-0636
Mailing address:
  • Phone: 913-422-5538
  • Fax: 913-367-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10638
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: