Healthcare Provider Details

I. General information

NPI: 1346522455
Provider Name (Legal Business Name): MRS. DAVID ANDREW WYLIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 SW GAGE BLVD
TOPEKA KS
66614-2927
US

IV. Provider business mailing address

2915 SW GAGE BLVD
TOPEKA KS
66614-2927
US

V. Phone/Fax

Practice location:
  • Phone: 785-379-9506
  • Fax:
Mailing address:
  • Phone: 785-379-9506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08862
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: