Individual
LARISSA LIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4747 S BROADWAY ST, WICHITA, KS 67216-1739
(316) 524-4228
(316) 529-9020
Mailing address
7818 W 19TH ST N, WICHITA, KS 67212-1496
(316) 524-4228
(316) 529-9020
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
14884
KS
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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