Provider Demographics
NPI:1932484284
Name:VENTER, ANJOMA (BPHARM)
Entity Type:Individual
Prefix:
First Name:ANJOMA
Middle Name:
Last Name:VENTER
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 N OSPREY CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3038
Mailing Address - Country:US
Mailing Address - Phone:316-990-9920
Mailing Address - Fax:
Practice Address - Street 1:3137 S SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3234
Practice Address - Country:US
Practice Address - Phone:316-945-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS19324842284OtherNPI