=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932138336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN TODD LANDERS PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 ALEX LN
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25304-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-926-6001
-----------------------------------------------------
Fax | 304-926-8692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 396
-----------------------------------------------------
City | POCA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25159-0396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-755-3263
-----------------------------------------------------
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 | RP0006104
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------