Provider Demographics
NPI:1336525955
Name:ALEXANDER, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ALEXANDER
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 1:1701 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114
Mailing Address - Country:US
Mailing Address - Phone:316-284-2333
Mailing Address - Fax:316-284-0698
Practice Address - Street 1:1701 S KANSAS RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8755
Practice Address - Country:US
Practice Address - Phone:316-284-2333
Practice Address - Fax:316-284-0698
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist