Individual
MARY NIKOULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2014 W 21ST ST N, WICHITA, KS 67203-2107
(316) 821-9678
Mailing address
1323 S ROCKY CREEK DR, WICHITA, KS 67230-2800
(316) 990-6866
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1-120395
KS
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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