Provider Demographics
NPI:1801179908
Name:HEIDA, KANDI KAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KANDI
Middle Name:KAY
Last Name:HEIDA
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 1:565 N BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4327
Mailing Address - Country:US
Mailing Address - Phone:402-659-5773
Mailing Address - Fax:
Practice Address - Street 1:565 N BRISTOL CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4327
Practice Address - Country:US
Practice Address - Phone:402-659-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS115555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKS1-15555OtherKANSAS STATE BOARD OF PHARMACY