Healthcare Provider Details

I. General information

NPI: 1033185954
Provider Name (Legal Business Name): MICHAEL ALLEN HEFLEY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 R.D. MIZE ROAD MARRS PHARMACY
BLUE SPRINGS MO
64014
US

IV. Provider business mailing address

19 EMERALD SHORE DR
BLUE SPRINGS MO
64015-9658
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-7755
  • Fax: 816-229-1052
Mailing address:
  • Phone: 816-229-7755
  • Fax: 816-229-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29099
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: