Provider Demographics
NPI:1578693974
Name:MAHONEY, SAM L (RPH PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:L
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15565 BOND STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221
Mailing Address - Country:US
Mailing Address - Phone:913-897-2624
Mailing Address - Fax:913-661-9979
Practice Address - Street 1:11844 QUIVIRA ROAD
Practice Address - Street 2:MAHONEYS PHARMACY
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1300
Practice Address - Country:US
Practice Address - Phone:913-661-9966
Practice Address - Fax:913-661-9979
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS9192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist