Healthcare Provider Details

I. General information

NPI: 1578846952
Provider Name (Legal Business Name): KENNETH HESTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S COMMERCIAL ST
HARRISONVILLE MO
64701-1651
US

IV. Provider business mailing address

4880 W 215TH ST
BUCYRUS KS
66013-9600
US

V. Phone/Fax

Practice location:
  • Phone: 816-884-1891
  • Fax:
Mailing address:
  • Phone: 913-406-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2000175628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: