Provider Demographics
NPI:1982226247
Name:KANSAL, MAYANK (PHARM D)
Entity Type:Individual
Prefix:
First Name:MAYANK
Middle Name:
Last Name:KANSAL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S ROBB ST STE B
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-7618
Mailing Address - Country:US
Mailing Address - Phone:936-594-3593
Mailing Address - Fax:
Practice Address - Street 1:507 S ROBB ST STE B
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7618
Practice Address - Country:US
Practice Address - Phone:936-594-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist