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NPI Code Detail

MEDICARE: CELESTE Y. ONTJES R.PH.

MEDICARE: CELESTE Y. ONTJES R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist1-2655KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-2655OTHERKSSTATE PHARMACY LICENSE

General Provider Information

NPI Number : 1417925223
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTE Y. ONTJES R.PH.
Provider Business Mailing Address
First Line : 7111 E 21ST ST N
Second Line : SUITE C
City : WICHITA
State : KS
Zip : 67206-1078
Country : US
Telephone Number : 316-684-7899
Fax Number : 316-684-8221
Provider Business Practice Location Address
First Line : 1100 N MAIN ST
Second Line :
City : HUTCHINSON
State : KS
Zip : 67501-4406
Country : US
Telephone Number : 316-669-6699
Fax Number : 316-669-6697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 07/08/2007

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