Provider Demographics
NPI:1205480837
Name:WYLAND, JANIS KAY (RPH)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:KAY
Last Name:WYLAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 NE 106TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1746
Mailing Address - Country:US
Mailing Address - Phone:816-769-7765
Mailing Address - Fax:
Practice Address - Street 1:1336 NE 106TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-1746
Practice Address - Country:US
Practice Address - Phone:816-769-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS042529183500000X
KS1-11277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO042529OtherMISSOURI STATE BOARD OF PHARMACY