Provider Demographics
NPI:1053687723
Name:IHRIG, MAXINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:
Last Name:IHRIG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 S EMERALD CIR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-9685
Mailing Address - Country:US
Mailing Address - Phone:316-776-9776
Mailing Address - Fax:
Practice Address - Street 1:6217 E 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2654
Practice Address - Country:US
Practice Address - Phone:316-683-5621
Practice Address - Fax:316-685-9608
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist