Provider Demographics
NPI:1588170120
Name:MAHLANDT, MATTHEW WAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WAYNE
Last Name:MAHLANDT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:W
Other - Last Name:MAHLANDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:413 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-9578
Mailing Address - Country:US
Mailing Address - Phone:316-519-4192
Mailing Address - Fax:
Practice Address - Street 1:3030 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1309
Practice Address - Country:US
Practice Address - Phone:316-636-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist