Provider Demographics
NPI:1396113783
Name:GALVAN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GALVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 NE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4602
Mailing Address - Country:US
Mailing Address - Phone:816-607-5152
Mailing Address - Fax:816-607-5162
Practice Address - Street 1:1198 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4602
Practice Address - Country:US
Practice Address - Phone:816-607-5152
Practice Address - Fax:816-607-5162
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-120478183500000X
MO2006011640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist