1013750983 NPI number — JATANDRA LEE BIRNEY PHARM.D.

Table of content: JATANDRA LEE BIRNEY PHARM.D. (NPI 1013750983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013750983 NPI number — JATANDRA LEE BIRNEY PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRNEY
Provider First Name:
JATANDRA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWENS
Provider Other First Name:
JATANDRA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013750983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4233 N WOODLAWN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIRE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67220-3836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-768-3056
Provider Business Mailing Address Fax Number:
316-768-8490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 NORTH SAINT FRANCIS STREET
Provider Second Line Business Practice Location Address:
LOWER LEVEL PHARMACY DEPARTMENT
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-268-5098
Provider Business Practice Location Address Fax Number:
316-768-8490
Provider Enumeration Date:
06/17/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  1-14682 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835X0200X , with the licence number: 1-14682 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)