Provider Demographics
NPI:1285902189
Name:NAIFEH, TOM (RPH)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:NAIFEH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E 13TH ST N UNIT 114
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1296
Mailing Address - Country:US
Mailing Address - Phone:316-636-5271
Mailing Address - Fax:316-636-5271
Practice Address - Street 1:1330 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2647
Practice Address - Country:US
Practice Address - Phone:316-684-2828
Practice Address - Fax:316-684-4450
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-08741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist