Individual
NELLIE NICOLE SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 685-2221
Mailing address
1402 W CALVERT ST, WICHITA, KS 67217-2722
(316) 932-8020
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
14-107167
KS
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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