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General NPI Number Information
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NPI Number | 1104641679
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Entity Type | Individual
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Provider Name | PHOG ALLEN CHARLES PYWELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 550 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4976
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Country | US
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Telephone | 316-962-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 191 S 135TH ST W UNIT 1022
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City | WICHITA
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State | KS
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Zip | 67235-5606
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Country | US
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Telephone | 316-821-8108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-105405
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License Number State | KS
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