MEDICARE: REBECCA LOUISE CULBERTSON RPH

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	40543	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568452597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LOUISE CULBERTSON RPH

Provider Business Mailing Address
First Line	:	201 W RD MIZE RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2513
Country	:	US
Telephone Number	:	816-655-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W RD MIZE RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2513
Country	:	US
Telephone Number	:	816-655-5434
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/26/2014

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