Provider Demographics
NPI:1801405139
Name:CHIMI-LAKBUB, ADELE BOTAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:BOTAN
Last Name:CHIMI-LAKBUB
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 1:1281 N MARTWAY DR APT 109
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7047
Mailing Address - Country:US
Mailing Address - Phone:901-220-8031
Mailing Address - Fax:
Practice Address - Street 1:4016 W 95TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2702
Practice Address - Country:US
Practice Address - Phone:913-307-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1100689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00000000OtherNONE