Healthcare Provider Details

I. General information

NPI: 1124110960
Provider Name (Legal Business Name): MR. KURT WILLIAM VOLLERTSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 S PENN AVE
OBERLIN KS
67749-2243
US

IV. Provider business mailing address

142 S PENN AVE
OBERLIN KS
67749-2243
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2285
  • Fax: 785-470-2470
Mailing address:
  • Phone: 785-475-2285
  • Fax: 785-470-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10195
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: