Provider Demographics
NPI:1194800789
Name:VOGELGESANG, TAREIA (RPH)
Entity type:Individual
Prefix:
First Name:TAREIA
Middle Name:
Last Name:VOGELGESANG
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 1:1000 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4208
Mailing Address - Country:US
Mailing Address - Phone:620-792-3030
Mailing Address - Fax:620-792-4971
Practice Address - Street 1:1000 ADAMS ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4208
Practice Address - Country:US
Practice Address - Phone:620-792-3030
Practice Address - Fax:620-792-4971
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770834111OtherNPI
KS5635950001Medicare ID - Type Unspecified