Individual
TIN T LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3211 S SENECA ST, WICHITA, KS 67217-3348
(316) 522-4545
Mailing address
3211 S SENECA ST, WICHITA, KS 67217-3348
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
1-100921
KS
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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