Provider Demographics
NPI:1164618856
Name:PONCE, PAOLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3598 N FOREST RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-4502
Mailing Address - Country:US
Mailing Address - Phone:303-957-8403
Mailing Address - Fax:
Practice Address - Street 1:2727 N MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7311
Practice Address - Country:US
Practice Address - Phone:316-721-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6581713-1701183500000X
KS1-14286183500000X
UT6581713-8911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist