Individual
HOA KY DO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1701 W 133RD ST, KANSAS CITY, MO 64145-1631
(816) 942-0476
Mailing address
9501 W 145TH TER, OVERLAND PARK, KS 66221-2557
(913) 706-0682
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
045281
MO
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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