Healthcare Provider Details

I. General information

NPI: 1144832569
Provider Name (Legal Business Name): CROSETTI HEALTH AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N MAIN ST
GRAIN VALLEY MO
64029
US

IV. Provider business mailing address

14145 HIGHWAY 24
LEXINGTON MO
64067-7202
US

V. Phone/Fax

Practice location:
  • Phone: 913-634-5347
  • Fax:
Mailing address:
  • Phone: 913-634-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEAN MICHAEL CROSETTI
Title or Position: CEO
Credential: PHARMD
Phone: 913-634-5347