Healthcare Provider Details

I. General information

NPI: 1821241316
Provider Name (Legal Business Name): FOUR B CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 S US HIGHWAY 71
GRANDVIEW MO
64030-1130
US

IV. Provider business mailing address

5300 SPEAKER RD
KANSAS CITY KS
66106-1050
US

V. Phone/Fax

Practice location:
  • Phone: 816-761-8767
  • Fax:
Mailing address:
  • Phone: 913-573-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HALLIWELL
Title or Position: DIRECTOR OF PHARMACY & WHOLE HEALTH
Credential: RPH
Phone: 913-573-1254