Tedene Halliwell, RPH
Individual provider Active NPI Pharmacist · Fairway, KS
NPI 1124461777 · NPPES record last updated Apr 14, 2013
Key facts
- NPI
- 1124461777
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 1-11759 (KS)
- Practice address
- 2724 W 53Rd St
Fairway, KS 66205-1705 - Phone
- (913) 236-4983
- NPI assigned
- Apr 14, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-11759 | KS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four B Corp | Past | Accepting new patients | |
| Four B Corp | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1-11759 | KS | Yes |
Addresses
Primary practice location
2724 W 53Rd St
Fairway, KS 66205-1705
Mailing address
2724 W 53Rd St
Fairway, KS 66205-1705
Phone (913) 236-4983
Other providers in Fairway, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.