MEDICARE: MR. THOMAS SQUIRES R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	043648	MO

General Provider Information

NPI Number	:	1194887653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS SQUIRES R.PH.

Provider Business Mailing Address
First Line	:	3545 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2501
Country	:	US
Telephone Number	:	816-231-2330
Fax Number	:	816-483-2301

Provider Business Practice Location Address
First Line	:	3545 BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2501
Country	:	US
Telephone Number	:	816-231-2330
Fax Number	:	816-483-2301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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