Organization
ULTRASOURCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANINE ANN BRIZENDINE R.PH. (PRESIDENT)
(316) 630-8170
Entity
Organization
Contact information
Practice address
2331 N BRANDON CIR, WICHITA, KS 67226-4511
(316) 630-8170
(316) 630-8170
Mailing address
2331 N BRANDON CIR, WICHITA, KS 67226-4511
(316) 630-8170
(316) 630-8170
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10876
KS
Other
Enumeration date
12/22/2005
Last updated
08/22/2020
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