Individual
KOURTNEY MAISOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
209 N DOUGLAS AVE, ELLSWORTH, KS 67439-3215
(785) 472-3131
Mailing address
209 N DOUGLAS AVE, ELLSWORTH, KS 67439-3215
(785) 472-3131
(785) 472-5771
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-16719
KS
Other
Enumeration date
05/10/2024
Last updated
05/10/2024
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