Healthcare Provider Details

I. General information

NPI: 1760781975
Provider Name (Legal Business Name): MONTE DEAN OVERCAST PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 N MCCLEARY RD
EXCELSIOR SPRINGS MO
64024-8490
US

IV. Provider business mailing address

8505 N EASTERN AVE
KANSAS CITY MO
64157-9577
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2972
  • Fax:
Mailing address:
  • Phone: 816-415-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2003015846
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: