Individual
JENNIFER PHETSAMONE PHACHANTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
550 N HILLSIDE ST STE 3-100, WICHITA, KS 67214-4910
(316) 962-4210
Mailing address
550 N HILLSIDE ST STE 3-100, WICHITA, KS 67214-4910
(316) 962-4210
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-109697
KS
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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