Provider Demographics
NPI:1588126619
Name:HOSEY, LON MARSHAL JR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:LON
Middle Name:MARSHAL
Last Name:HOSEY
Suffix:JR
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:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-0028
Mailing Address - Country:US
Mailing Address - Phone:316-708-7626
Mailing Address - Fax:
Practice Address - Street 1:11411 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1928
Practice Address - Country:US
Practice Address - Phone:316-683-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-106260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist