Provider Demographics
NPI:1700129699
Name:VIA CHRISTI PHARMACY
Entity Type:Organization
Organization Name:VIA CHRISTI PHARMACY
Other - Org Name:VIA CHRISTI OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRELTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-268-5580
Mailing Address - Street 1:929 N SAINT FRANCIS ST
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3821
Mailing Address - Country:US
Mailing Address - Phone:316-613-6511
Mailing Address - Fax:316-613-6517
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-613-6511
Practice Address - Fax:316-613-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2104393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720704OtherNCPDP PROVIDER IDENTIFICATION NUMBER