Provider Demographics
NPI:1326035668
Name:JANCICH, MARY KATHLEEN (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN
Last Name:JANCICH
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:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:KS
Mailing Address - Zip Code:66087-0091
Mailing Address - Country:US
Mailing Address - Phone:913-422-5538
Mailing Address - Fax:913-367-0636
Practice Address - Street 1:701 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2434
Practice Address - Country:US
Practice Address - Phone:913-367-4113
Practice Address - Fax:913-367-0636
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10638183500000X
MO044855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist