1699087155 NPI number — HOLLY SHARZAD SKELTON PHARM D

Table of content: HOLLY SHARZAD SKELTON PHARM D (NPI 1699087155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699087155 NPI number — HOLLY SHARZAD SKELTON PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKELTON
Provider First Name:
HOLLY
Provider Middle Name:
SHARZAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699087155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 NW VICTORIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64086-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-875-5111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-943-4879
Provider Business Practice Location Address Fax Number:
816-943-4882
Provider Enumeration Date:
07/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  2010023011 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114889 . This is a "PHARMACIST" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14333 . This is a "PHARMACIST" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 50207 . This is a "PHARMACIST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 02002216138 . This is a "PHARMACIST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: RP0010157 . This is a "PHARMACIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: RPH0016519 . This is a "PHARMACIST" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 2010023011 . This is a "PHARMACIST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: NP000416 . This is a "PHARMACIST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PD13927 . This is a "PHARMACIST" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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