Individual
GLEN M MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
400 W SAINT JOHN ST, GIRARD, KS 66743-1213
(620) 724-4313
(620) 724-6900
Mailing address
400 W SAINT JOHN ST, GIRARD, KS 66743-1213
(620) 724-4313
(620) 724-6900
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
206354
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100435000A
—
KS
Enumeration date
07/19/2006
Last updated
09/29/2020
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