Individual
MALLORY PARADIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
509 STATE ST, AUGUSTA, KS 67010-1107
(316) 775-2289
(316) 775-2280
Mailing address
509 STATE ST, AUGUSTA, KS 67010-1107
(316) 775-2289
(316) 775-2280
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
116109
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100434400A
—
KS
Enumeration date
09/22/2014
Last updated
09/22/2014
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