Healthcare Provider Details

I. General information

NPI: 1548616634
Provider Name (Legal Business Name): KEITH LYNN HAYDEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 N AMIDON AVE
WICHITA KS
67203-2116
US

IV. Provider business mailing address

2111 N AMIDON AVE
WICHITA KS
67203-2116
US

V. Phone/Fax

Practice location:
  • Phone: 316-361-3332
  • Fax:
Mailing address:
  • Phone: 316-361-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number9560
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: