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General NPI Number Information
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NPI Number | 1306239538
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Entity Type | Organization
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Legal Business Name | PRESTON PHARMACY
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 2622 W CENTRAL AVE STE 302
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City | WICHITA
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State | KS
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Zip | 67203-4973
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Country | US
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Telephone | 316-265-3300
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Fax | 316-265-3304
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Provider Business Mailing Address
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Address Line | 2622 W CENTRAL AVE STE 302
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City | WICHITA
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State | KS
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Zip | 67203-4973
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Country | US
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Telephone | 316-265-3300
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Fax |
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Authorized Official
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Title or Position | STAFF/CONSULTING PHARMACIST
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Name | LEW R ENNS
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Credential | RPH
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Telephone | 316-265-3300
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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 | 1-12291
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License Number State | KS
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