Provider Demographics
NPI:1013750983
Name:BIRNEY, JATANDRA LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:JATANDRA
Middle Name:LEE
Last Name:BIRNEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JATANDRA
Other - Middle Name:LEE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4233 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3836
Mailing Address - Country:US
Mailing Address - Phone:443-768-3056
Mailing Address - Fax:316-768-8490
Practice Address - Street 1:929 NORTH SAINT FRANCIS STREET
Practice Address - Street 2:LOWER LEVEL PHARMACY DEPARTMENT
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:316-268-5098
Practice Address - Fax:316-768-8490
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14682183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist