Provider Demographics
NPI:1417925223
Name:ONTJES, CELESTE Y (RPH)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:Y
Last Name:ONTJES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 E 21ST ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1078
Mailing Address - Country:US
Mailing Address - Phone:316-684-7899
Mailing Address - Fax:316-684-8221
Practice Address - Street 1:1100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4406
Practice Address - Country:US
Practice Address - Phone:316-669-6699
Practice Address - Fax:316-669-6697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-2655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-2655OtherSTATE PHARMACY LICENSE