Healthcare Provider Details

I. General information

NPI: 1255931044
Provider Name (Legal Business Name): DEA SUN DEUSER PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE CORONADO DR
BLUE SPRINGS MO
64014-3084
US

IV. Provider business mailing address

26707 E HUNTER RD
SIBLEY MO
64088-9572
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-2801
  • Fax: 816-228-0895
Mailing address:
  • Phone: 636-544-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016033996
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: