Healthcare Provider Details

I. General information

NPI: 1003263252
Provider Name (Legal Business Name): JERRY FRANKLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 ELMHURST BLVD SUITE A
SALINA KS
67401-7405
US

IV. Provider business mailing address

809 ELMHURST SUITE A
SALINA KS
67401
US

V. Phone/Fax

Practice location:
  • Phone: 785-914-5491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number1-09675
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: