Healthcare Provider Details

I. General information

NPI: 1972416600
Provider Name (Legal Business Name): CHRIS DURHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

IV. Provider business mailing address

31551 W HARRY ST
GARDEN PLAIN KS
67050-9169
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-2126
  • Fax:
Mailing address:
  • Phone: 316-962-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number1-12852
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: