Provider Demographics
NPI:1548616634
Name:HAYDEN, KEITH LYNN (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:LYNN
Last Name:HAYDEN
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 1:2111 N AMIDON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2116
Mailing Address - Country:US
Mailing Address - Phone:316-361-3332
Mailing Address - Fax:
Practice Address - Street 1:2111 N AMIDON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2116
Practice Address - Country:US
Practice Address - Phone:316-361-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS95601835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care