Provider Demographics
NPI:1821109315
Name:WEST, JANE L (D PH)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 W HARDTNER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-7537
Mailing Address - Country:US
Mailing Address - Phone:405-269-7571
Mailing Address - Fax:
Practice Address - Street 1:13601 W HARDTNER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-7537
Practice Address - Country:US
Practice Address - Phone:405-269-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11022183500000X
KS1-11117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist