Provider Demographics
NPI:1902363377
Name:MAYABI, MICHAEL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAYABI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11162 RENNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-9621
Mailing Address - Country:US
Mailing Address - Phone:800-360-0520
Mailing Address - Fax:
Practice Address - Street 1:11162 RENNER BLVD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-9621
Practice Address - Country:US
Practice Address - Phone:800-360-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS116490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist