Healthcare Provider Details

I. General information

NPI: 1477204105
Provider Name (Legal Business Name): ABEL PLOTNIKOV PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 CLINTON PKWY
LAWRENCE KS
66047-2145
US

IV. Provider business mailing address

1117 NATALIE DR
LAWRENCE KS
66046-5169
US

V. Phone/Fax

Practice location:
  • Phone: 785-832-0110
  • Fax:
Mailing address:
  • Phone: 785-760-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-103843
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: