Healthcare Provider Details

I. General information

NPI: 1588185110
Provider Name (Legal Business Name): MARWA KHAMIS BUSER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 W CENTRAL AVE STE 302
WICHITA KS
67203-4973
US

IV. Provider business mailing address

12609 E LINCOLN CT
WICHITA KS
67207-7016
US

V. Phone/Fax

Practice location:
  • Phone: 316-265-3300
  • Fax:
Mailing address:
  • Phone: 785-341-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-15032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: