Healthcare Provider Details

I. General information

NPI: 1659325918
Provider Name (Legal Business Name): GHODRAT ATTARZADEH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR ROBERT J.DOLE MEDICAL CENTER
WICHITA KS
67218-1607
US

IV. Provider business mailing address

10206 E 19TH ST N
WICHITA KS
67206-8931
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax:
Mailing address:
  • Phone: 316-685-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number1-09227
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: