Healthcare Provider Details

I. General information

NPI: 1801514690
Provider Name (Legal Business Name): COLE MICHAEL KITTERMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CLOUD AVE
ANDOVER KS
67002-8824
US

IV. Provider business mailing address

3617 WHISPERING BROOK CT
WICHITA KS
67220-4406
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-3726
  • Fax: 316-733-3729
Mailing address:
  • Phone: 316-616-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-107191
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: