Individual
KHANTHALY PHOMMATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 E SANTA FE ST, OLATHE, KS 66062-1606
(913) 782-2323
Mailing address
1034 E COTTAGE CREEK CIR, GARDNER, KS 66030-8406
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
14-100562
KS
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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