Provider Demographics
NPI:1174605430
Name:GALEMORE, NICHOLAS KENT (RPH)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:KENT
Last Name:GALEMORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W MAIN ST
Mailing Address - Street 2:PO BOX C
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1607
Mailing Address - Country:US
Mailing Address - Phone:620-431-7193
Mailing Address - Fax:620-431-7741
Practice Address - Street 1:421 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1607
Practice Address - Country:US
Practice Address - Phone:620-431-7193
Practice Address - Fax:620-431-7741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11805183500000X
KSKS 1-11805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist