Healthcare Provider Details

I. General information

NPI: 1235054263
Provider Name (Legal Business Name): ETHAN DODD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1136
US

IV. Provider business mailing address

6807 SUMMIT ST
SHAWNEE KS
66216-2376
US

V. Phone/Fax

Practice location:
  • Phone: 816-613-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2023028976
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: