Basic Information
| Provider Information | |||||||||
| NPI: | 1013552629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELIAS-MOUSSA | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N SAINT FRANCIS AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672142865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162643505 | ||||||||
| FaxNumber: | 3162640978 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 N SAINT FRANCIS AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672142865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162643505 | ||||||||
| FaxNumber: | 3162640978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 1-12697 | KS | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.