Khanthaly Phommata

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

14-100562 Issued in KS

Practice address

2101 E Santa Fe St
Olathe, KS 66062-1606

Phone

(913) 782-2323

NPI assigned

Aug 24, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Four B Corp

  • Pharmacy
  • Olathe, KS
  • NPI 1639284730
  NPD (past)
• Four B Corp

  • Pharmacy
  • Prairie Village, KS
  • NPI 1942735501
  NPD (past)

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": []
}

• PFD Partnership, LLC
• Christa L. Phillips, LMSW
• James R Phillips, DO
• Stephanie Rae Wise Phillips, CSW
• Phoenix Mental Health LLC
• Phye Family Dentistry, P.a.
• Bryant Evans Phye, D.D.S.
• Vanessa C Phye
• Physicians Optical, Inc
• Physicians Reference Laboratory LLC

• Pharmacy Technician in Olathe, KS
• Providers in Olathe, KS by specialty
• Pharmacy Technician in Kansas

• 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.

Verify at the official NPI Registry.