Provider Demographics
NPI:1396114641
Name:MONFARED, MINOO M (PHARM-D)
Entity type:Individual
Prefix:MRS
First Name:MINOO
Middle Name:M
Last Name:MONFARED
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5104
Mailing Address - Country:US
Mailing Address - Phone:316-448-4257
Mailing Address - Fax:
Practice Address - Street 1:10550 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5104
Practice Address - Country:US
Practice Address - Phone:316-448-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13347183500000X
TX36809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist