Healthcare Provider Details

I. General information

NPI: 1669145116
Provider Name (Legal Business Name): JACOB ALLEN HUFFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 E MEYER BLVD
KANSAS CITY MO
64132-1199
US

IV. Provider business mailing address

5925 HOLMES ST
KANSAS CITY MO
64110-3031
US

V. Phone/Fax

Practice location:
  • Phone: 816-276-4000
  • Fax:
Mailing address:
  • Phone: 816-456-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021029273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: