Healthcare Provider Details

I. General information

NPI: 1891571972
Provider Name (Legal Business Name): KRISTEN MARIE MIZE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 COLLEGE BLVD STE 600
OVERLAND PARK KS
66210-2083
US

IV. Provider business mailing address

1903 CRESTWOOD DR
HARRISONVILLE MO
64701-1135
US

V. Phone/Fax

Practice location:
  • Phone: 816-724-6895
  • Fax:
Mailing address:
  • Phone: 816-724-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022028384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: