MEDICARE: ELVIS TAKU AGBOR

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	2020023377	MO

General Provider Information

NPI Number	:	1942802053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIS TAKU AGBOR

Provider Business Mailing Address
First Line	:	310 W 99TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4365
Country	:	US
Telephone Number	:	708-724-6710
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 SW US HIGHWAY 40
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-3232
Country	:	US
Telephone Number	:	816-224-4277
Fax Number	:

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	11/12/2020

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Directions to “ ELVIS TAKU AGBOR ” Practice Location

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