Healthcare Provider Details

I. General information

NPI: 1801807987
Provider Name (Legal Business Name): TAMMY TWAIT DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 12TH ST SUITE 227
KANSAS CITY MO
64106-2818
US

IV. Provider business mailing address

13700 W 69TH ST
SHAWNEE KS
66216-2308
US

V. Phone/Fax

Practice location:
  • Phone: 816-426-5783
  • Fax: 816-426-7604
Mailing address:
  • Phone: 913-268-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10454
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-11320
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: