Healthcare Provider Details

I. General information

NPI: 1467861963
Provider Name (Legal Business Name): SADEGH EFTEKHARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N MAIZE RD
WICHITA KS
67212-4655
US

IV. Provider business mailing address

4254 N STRATFORD LN
BEL AIRE KS
67226-1400
US

V. Phone/Fax

Practice location:
  • Phone: 316-729-6171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116606
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: