Active NPI
Khanthaly Phommata
- Pharmacy Technician
- Olathe, KS
National Provider Identifier
1225757065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 14-100562
- Practice address
- 2101 E Santa Fe St
Olathe, KS 66062-1606 - Phone
- (913) 782-2323
- NPI assigned
- Aug 24, 2022
- Last updated
- Aug 24, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 14-100562 | KS | Primary |
Addresses
Primary practice location
2101 E Santa Fe St
Olathe, KS 66062-1606
Mailing address
1034 E Cottage Creek Cir
Gardner, KS 66030-8406
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 |
|---|---|---|---|
| 14-100562 | KS | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four B Corp | Past | Accepting new patients | |
| Four B Corp | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1225757065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1034 E COTTAGE CREEK CIR",
"city": "GARDNER",
"state": "KS",
"postal_code": "660308406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 E SANTA FE ST",
"city": "OLATHE",
"state": "KS",
"postal_code": "660621606",
"telephone_number": "913-782-2323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOMMATA",
"first_name": "KHANTHALY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-24",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "KS",
"license": "14-100562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olathe, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.