Provider Demographics
NPI:1114018108
Name:GUYLL, CARL G (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:G
Last Name:GUYLL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PENN AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3012
Mailing Address - Country:US
Mailing Address - Phone:620-331-0036
Mailing Address - Fax:620-331-0593
Practice Address - Street 1:400 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3012
Practice Address - Country:US
Practice Address - Phone:620-331-0036
Practice Address - Fax:620-331-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist