Healthcare Provider Details

I. General information

NPI: 1831175637
Provider Name (Legal Business Name): MARY A. ROONEY R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STATE HOSPITAL DRIVE OSAWATOMIE STATE HOSPITAL PHARMACY
OSAWATOMIE KS
66071
US

IV. Provider business mailing address

11390 W 359TH ST
PAOLA KS
66071-8106
US

V. Phone/Fax

Practice location:
  • Phone: 913-755-7215
  • Fax: 913-755-7044
Mailing address:
  • Phone: 913-980-3329
  • Fax: 913-377-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number10678
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: