Provider Demographics
NPI:1780092536
Name:TOMASU, KAY
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:TOMASU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 W MEADOW PASS CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1611
Mailing Address - Country:US
Mailing Address - Phone:316-729-0431
Mailing Address - Fax:316-729-2200
Practice Address - Street 1:10515 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5103
Practice Address - Country:US
Practice Address - Phone:316-729-0431
Practice Address - Fax:316-729-2200
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100431270AMedicaid