Provider Demographics
NPI:1043337934
Name:KOJAN, AMIRA
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:KOJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14421 W 121ST TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6057
Mailing Address - Country:US
Mailing Address - Phone:913-780-1775
Mailing Address - Fax:
Practice Address - Street 1:16100 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1517
Practice Address - Country:US
Practice Address - Phone:913-780-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist