Active NPI
Andy Phan
- Pharmacist
- Liberal, KS
National Provider Identifier
1043680333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1-17013
- Practice address
- 407 N Sherman Ave
Liberal, KS 67901-3246 - Phone
- (620) 417-7230
- Fax
- (620) 417-7233
- NPI assigned
- Sep 30, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1-17013 | KS | Primary |
Addresses
Primary practice location
407 N Sherman Ave
Liberal, KS 67901-3246
Mailing address
412 N. Western Ave.
Liberal, KS 67901
Phone (620) 417-7230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-17013 | KS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443571200000",
"number": "1043680333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 N. WESTERN AVE.",
"city": "LIBERAL",
"state": "KS",
"postal_code": "67901",
"telephone_number": "620-417-7230",
"fax_number": "620-417-7233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 N SHERMAN AVE",
"city": "LIBERAL",
"state": "KS",
"postal_code": "679013246",
"telephone_number": "620-417-7230",
"fax_number": "620-417-7233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "ANDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-30",
"last_updated": "2015-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KS",
"license": "1-17013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liberal, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.