Provider Demographics
NPI:1427432202
Name:AUDRAIN, MISHAWN (PHARM D)
Entity type:Individual
Prefix:
First Name:MISHAWN
Middle Name:
Last Name:AUDRAIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 E TALLOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-1709
Mailing Address - Country:US
Mailing Address - Phone:316-644-8123
Mailing Address - Fax:
Practice Address - Street 1:6110 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2361
Practice Address - Country:US
Practice Address - Phone:316-945-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist