Healthcare Provider Details

I. General information

NPI: 1598843260
Provider Name (Legal Business Name): CONNIE VILLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 TUCKER RD
PLEASANTON KS
66075-8402
US

IV. Provider business mailing address

PO BOX 583
PLEASANTON KS
66075-0583
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1400823
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: