Provider Demographics
NPI:1407459720
Name:MAYNEZ, PAMELA LIZETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LIZETH
Last Name:MAYNEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3752
Mailing Address - Country:US
Mailing Address - Phone:316-448-4554
Mailing Address - Fax:
Practice Address - Street 1:2024 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3752
Practice Address - Country:US
Practice Address - Phone:316-448-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1106322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist