Healthcare Provider Details

I. General information

NPI: 1225522683
Provider Name (Legal Business Name): ALONNA DANAE GALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 SE LOUIS DR
MULVANE KS
67110-1109
US

IV. Provider business mailing address

121 W MAIN ST APT B
MULVANE KS
67110-1764
US

V. Phone/Fax

Practice location:
  • Phone: 316-777-1601
  • Fax:
Mailing address:
  • Phone: 316-734-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14101295
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: