Basic Information
| Provider Information | |||||||||
| NPI: | 1992412878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIANG | ||||||||
| FirstName: | TERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 S BURRUS ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672073609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166168740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9450 E HARRY ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672075074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166512732 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2022 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 1-103970 | KS | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.