Provider Demographics
NPI:1194313411
Name:GALLEGOS, JIHAN WIDAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JIHAN
Middle Name:WIDAD
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JIHAN
Other - Middle Name:WIDAD
Other - Last Name:EL-GHUSSEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2955
Mailing Address - Country:US
Mailing Address - Phone:913-730-8731
Mailing Address - Fax:844-842-0014
Practice Address - Street 1:311 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1303
Practice Address - Country:US
Practice Address - Phone:913-294-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist