Provider Demographics
NPI:1083152540
Name:TEJEDA, RAY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:TEJEDA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-1620
Mailing Address - Country:US
Mailing Address - Phone:316-831-9057
Mailing Address - Fax:
Practice Address - Street 1:5475 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-1620
Practice Address - Country:US
Practice Address - Phone:316-831-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-106101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist