Healthcare Provider Details

I. General information

NPI: 1710569611
Provider Name (Legal Business Name): CHELSEA LOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 E 21ST ST N
WICHITA KS
67206-2900
US

IV. Provider business mailing address

1209 N WESTVIEW DR
DERBY KS
67037-2712
US

V. Phone/Fax

Practice location:
  • Phone: 316-609-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number1100846
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: