Healthcare Provider Details

I. General information

NPI: 1568291573
Provider Name (Legal Business Name): MALENA LANDWEHR PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 PAWNEE ST
CLINTON MO
64735-2757
US

IV. Provider business mailing address

114 SE DOUGLAS ST UNIT 271
LEES SUMMIT MO
64063-3198
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-3034
  • Fax:
Mailing address:
  • Phone: 417-293-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024030011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: