Provider Demographics
NPI:1497428031
Name:CONTRERAS-AVILA, MIGUEL ANGEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIGUEL ANGEL
Middle Name:
Last Name:CONTRERAS-AVILA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6304 W THORSTENBURG RD
Mailing Address - Street 2:
Mailing Address - City:FALUN
Mailing Address - State:KS
Mailing Address - Zip Code:67442-9704
Mailing Address - Country:US
Mailing Address - Phone:785-212-9207
Mailing Address - Fax:
Practice Address - Street 1:205 S CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4012
Practice Address - Country:US
Practice Address - Phone:620-241-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist