Healthcare Provider Details

I. General information

NPI: 1043337934
Provider Name (Legal Business Name): AMIRA KOJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 W 135TH ST
OLATHE KS
66062-1517
US

IV. Provider business mailing address

14421 W 121ST TER
OLATHE KS
66062-6057
US

V. Phone/Fax

Practice location:
  • Phone: 913-780-9449
  • Fax:
Mailing address:
  • Phone: 913-780-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-14131
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: