Provider Demographics
NPI:1366042871
Name:VANG, MYSHENYENNE
Entity Type:Individual
Prefix:
First Name:MYSHENYENNE
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7523 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1045
Mailing Address - Country:US
Mailing Address - Phone:816-534-4883
Mailing Address - Fax:
Practice Address - Street 1:301 E COOPER BLVD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1260
Practice Address - Country:US
Practice Address - Phone:660-747-8677
Practice Address - Fax:660-747-5244
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist