Provider Demographics
NPI:1194184986
Name:MAHANKALI, MUKTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MUKTA
Middle Name:
Last Name:MAHANKALI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BRENNER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-1163
Mailing Address - Country:US
Mailing Address - Phone:816-249-2780
Mailing Address - Fax:
Practice Address - Street 1:4300 BRENNER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-1163
Practice Address - Country:US
Practice Address - Phone:816-249-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist