MEDICARE: MRS. DENISE JEAN RIFE PHARMACIST

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
1	1835P1200X	Pharmacotherapy Pharmacist	12372	KS

General Provider Information

NPI Number	:	1912288614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE JEAN RIFE PHARMACIST

Provider Business Mailing Address
First Line	:	4657 S 159TH ST E
Second Line	:
City	:	ROSE HILL
State	:	KS
Zip	:	67133-9618
Country	:	US
Telephone Number	:	316-733-5707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 S WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67207-5601
Country	:	US
Telephone Number	:	316-652-9147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	09/08/2011

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