=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316619893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK GALANG PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2021
-----------------------------------------------------
Last Update Date | 10/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3421 W 6TH ST
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66049-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-841-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6509 W 134TH ST
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66209-4089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-940-9383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 1-107452
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------