Healthcare Provider Details

I. General information

NPI: 1427930882
Provider Name (Legal Business Name): CALEB VREDENBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 SPEAKER RD
KANSAS CITY KS
66106-1050
US

IV. Provider business mailing address

5300 SPEAKER RD
KANSAS CITY KS
66106-1050
US

V. Phone/Fax

Practice location:
  • Phone: 913-321-4223
  • Fax:
Mailing address:
  • Phone: 913-321-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-110106
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: