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General NPI Number Information
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NPI Number | 1629588454
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD PHARMACY 0002 LLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 328 E PAWNEE ST
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City | WICHITA
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State | KS
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Zip | 67211-4847
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Country | US
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Telephone | 316-665-4427
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Fax | 888-252-7110
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Provider Business Mailing Address
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Address Line | PO BOX 685
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City | WICHITA
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State | KS
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Zip | 67201-0685
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Country | US
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Telephone | 316-665-4427
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Fax | 888-252-7110
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Authorized Official
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Title or Position | OWNER
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Name | MR. EBUBE OTUONYE
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Credential | RPH
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Telephone | 316-665-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2-103547
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License Number State | KS
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