Organization
ACTIVE LIFESTYLE PHARMACY LLC
Active
Organization
ACTIVE LIFESTYLE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB M LICKTEIG (PRESIDENT)
(785) 760-3839
Entity
Organization
Contact information
Practice address
7800 FOSTER ST, OVERLAND PARK, KS 66204-2955
(913) 730-8731
(844) 842-0014
Mailing address
7800 FOSTER ST, OVERLAND PARK, KS 66204-2955
(913) 730-8731
(844) 842-0014
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/27/2019
Last updated
12/27/2019
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