Healthcare Provider Details

I. General information

NPI: 1194800789
Provider Name (Legal Business Name): TAREIA VOGELGESANG R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ADAMS ST
GREAT BEND KS
67530-4208
US

IV. Provider business mailing address

1000 ADAMS ST
GREAT BEND KS
67530-4208
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-3030
  • Fax: 620-792-4971
Mailing address:
  • Phone: 620-792-3030
  • Fax: 620-792-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-10390
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: