Healthcare Provider Details

I. General information

NPI: 1417238445
Provider Name (Legal Business Name): BRECCA KOWALSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2011
Last Update Date: 09/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13534 W MAPLE ST
WICHITA KS
67235-8754
US

IV. Provider business mailing address

13534 W MAPLE ST
WICHITA KS
67235-8754
US

V. Phone/Fax

Practice location:
  • Phone: 316-773-3162
  • Fax: 316-773-1526
Mailing address:
  • Phone: 316-773-3162
  • Fax: 316-773-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13601
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: