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General NPI Number Information
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NPI Number | 1366042871
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Entity Type | Individual
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Provider Name | MYSHENYENNE VANG
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 301 E COOPER BLVD
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City | WARRENSBURG
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State | MO
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Zip | 64093-1260
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Country | US
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Telephone | 660-747-8677
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Fax | 660-747-5244
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Provider Business Mailing Address
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Address Line | 7523 N KENTUCKY AVE
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City | KANSAS CITY
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State | MO
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Zip | 64158-1045
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Country | US
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Telephone | 816-534-4883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2018045272
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License Number State | MO
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