Individual
MR. BRIAN PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
12430 W EBERLY CT, WICHITA, KS 67235-9649
(913) 669-9125
Mailing address
12430 W EBERLY CT, WICHITA, KS 67235-9649
(913) 669-9125
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-13187
KS
183500000X
Pharmacist
20030018137
MO
183500000X
Pharmacist
36320
TX
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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