Provider Demographics
NPI:1881012888
Name:HOOVER, MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOOVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 W 130TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3478
Mailing Address - Country:US
Mailing Address - Phone:913-681-5156
Mailing Address - Fax:913-681-5156
Practice Address - Street 1:10601 W 130TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-3478
Practice Address - Country:US
Practice Address - Phone:913-681-5156
Practice Address - Fax:913-681-5156
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist