Healthcare Provider Details

I. General information

NPI: 1568829141
Provider Name (Legal Business Name): JUDD CARPENTER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13634 W 129TH PL
OLATHE KS
66062-8824
US

IV. Provider business mailing address

13634 W 129TH PL
OLATHE KS
66062-8824
US

V. Phone/Fax

Practice location:
  • Phone: 816-694-5784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number1-14856
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number2008027503
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: