Healthcare Provider Details

I. General information

NPI: 1851123145
Provider Name (Legal Business Name): ALYSSA DAWN PUTMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

13200 GOODMAN ST APT 3202
OVERLAND PARK KS
66213-7808
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 913-609-6107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-104987
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: