Provider Demographics
NPI:1346344587
Name:MAHANNA, DAVID R (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:MAHANNA
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 1:833 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-0288
Mailing Address - Country:US
Mailing Address - Phone:785-675-3461
Mailing Address - Fax:785-675-3112
Practice Address - Street 1:833 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-0288
Practice Address - Country:US
Practice Address - Phone:785-675-3461
Practice Address - Fax:785-675-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0534130001Medicare ID - Type Unspecified