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General NPI Number Information
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NPI Number | 1992107627
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Entity Type | Organization
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Legal Business Name | MUNSON ARMY HEALTH CENTER
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 550 POPE AVE BLDG 343, ROOM 1A146
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 550 POPE AVE BLDG 343, ROOM 1A146
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6054
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Fax |
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Authorized Official
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Title or Position | CHIEF, PHARMACY SERVICES
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Name | DR. APARNA BARBARA RAIZADA
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Credential | PHARM.D.
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Telephone | 913-684-6054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State | NULL
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