MEDICARE: BENJAMIN KACNER

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	KS-14473	KS

General Provider Information

NPI Number	:	1649548736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN KACNER

Provider Business Mailing Address
First Line	:	2850 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4038
Country	:	US
Telephone Number	:	913-621-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4038
Country	:	US
Telephone Number	:	913-621-7073
Fax Number	:

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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