Healthcare Provider Details

I. General information

NPI: 1568691939
Provider Name (Legal Business Name): KANSAS PALLIATIVE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S MARKET ST
WICHITA KS
67202-3805
US

IV. Provider business mailing address

313 S MARKET ST
WICHITA KS
67202
US

V. Phone/Fax

Practice location:
  • Phone: 316-265-9441
  • Fax: 316-265-8657
Mailing address:
  • Phone: 316-265-9441
  • Fax: 316-265-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2-09405
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA SNYDER
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential: RPH
Phone: 316-268-9441