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General NPI Number Information
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NPI Number | 1679584890
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Entity Type | Organization
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Legal Business Name | ASCENSION MEDICAL GROUP VIA CHRISTI, PA
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 3311 E MURDOCK ST
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City | WICHITA
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State | KS
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Zip | 67208-3054
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Country | US
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Telephone | 316-274-8280
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Fax | 316-274-8438
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Provider Business Mailing Address
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Address Line | 3311 E MURDOCK ST
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City | WICHITA
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State | KS
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Zip | 67208-3054
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Country | US
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Telephone | 316-274-8280
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Fax | 316-274-8438
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | JACQUE STEARNS
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Credential | RPH
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Telephone | 316-274-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2-10323
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License Number State | KS
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