Provider Demographics
NPI:1710539200
Name:MOGONDO, SILAS
Entity Type:Individual
Prefix:
First Name:SILAS
Middle Name:
Last Name:MOGONDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2150
Mailing Address - Country:US
Mailing Address - Phone:913-789-9275
Mailing Address - Fax:
Practice Address - Street 1:9011 RENNER BLVD APT 2901
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-3027
Practice Address - Country:US
Practice Address - Phone:913-963-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-1068331835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy