Healthcare Provider Details

I. General information

NPI: 1215855531
Provider Name (Legal Business Name): KYLE LEE ROOF PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

IV. Provider business mailing address

1224 MILWAUKEE ST
EXCELSIOR SPRINGS MO
64024-1129
US

V. Phone/Fax

Practice location:
  • Phone: 816-629-3667
  • Fax: 816-629-2719
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021029664
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: