Healthcare Provider Details

I. General information

NPI: 1780800557
Provider Name (Legal Business Name): CHARLES PHILIP BUMPUS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 N COSBY AVE
KANSAS CITY MO
64151-2378
US

IV. Provider business mailing address

8315 N MARSTON AVE
KANSAS CITY MO
64151-3715
US

V. Phone/Fax

Practice location:
  • Phone: 816-505-4410
  • Fax:
Mailing address:
  • Phone: 816-436-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005036831
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202004177
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: