Provider Demographics
NPI:1962103846
Name:CHI, DIVINE N (PHARMD)
Entity type:Individual
Prefix:
First Name:DIVINE
Middle Name:N
Last Name:CHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15123 S OMC PKWY
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7251
Mailing Address - Country:US
Mailing Address - Phone:913-314-9839
Mailing Address - Fax:
Practice Address - Street 1:15123 S OMC PKWY
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7251
Practice Address - Country:US
Practice Address - Phone:913-355-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-167461835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology