Individual
TAMBOUE ESAIE DEFFO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD,RPH
Contact information
Practice address
13600 S ALDEN ST, OLATHE, KS 66062-5829
(913) 539-8300
Mailing address
5311 HALLET ST, SHAWNEE, KS 66216-5147
(913) 575-3414
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11652
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11652
PHARMACY LICENSE
KS
Enumeration date
08/27/2018
Last updated
08/27/2018
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