Active NPI
Kenneth Gandaho, PHARM D
- Pharmacist
- Saint Charles, MO
National Provider Identifier
1194329367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2018037591
- Practice address
- 3881 Mexico Rd
Saint Charles, MO 63303-3042 - Phone
- (636) 922-3064
- NPI assigned
- Nov 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2018037591 | MO | Primary |
Addresses
Primary practice location
3881 Mexico Rd
Saint Charles, MO 63303-3042
Mailing address
709 Palace CT
Ferguson, MO 63135-1748
Phone (314) 445-8090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018037591 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606521600000",
"number": "1194329367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 PALACE CT",
"city": "FERGUSON",
"state": "MO",
"postal_code": "631351748",
"telephone_number": "314-445-8090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3881 MEXICO RD",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633033042",
"telephone_number": "636-922-3064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDAHO",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-28",
"last_updated": "2020-11-28",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2018037591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.