Provider Demographics
NPI:1811509789
Name:MUNGUYA, WILLIAM LUZENDU (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LUZENDU
Last Name:MUNGUYA
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 1:1101 N BEDFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4354
Mailing Address - Country:US
Mailing Address - Phone:316-680-8867
Mailing Address - Fax:
Practice Address - Street 1:803 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3509
Practice Address - Country:US
Practice Address - Phone:316-768-5450
Practice Address - Fax:316-768-5452
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist