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NPI Code Detail

MEDICARE: DR. PAOLA PONCE PHARM.D.

MEDICARE: DR. PAOLA PONCE PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist6581713-1701UT
2183500000XPharmacist1-14286KS
3183500000XPharmacist6581713-8911UT

General Provider Information

NPI Number : 1164618856
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAOLA PONCE PHARM.D.
Provider Business Mailing Address
First Line : 3598 N FOREST RIDGE ST
Second Line :
City : WICHITA
State : KS
Zip : 67205-4502
Country : US
Telephone Number : 303-957-8403
Fax Number :
Provider Business Practice Location Address
First Line : 2727 N MAIZE RD
Second Line :
City : WICHITA
State : KS
Zip : 67205-7311
Country : US
Telephone Number : 316-721-4289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2007
Last Update Date : 08/13/2014

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