Healthcare Provider Details

I. General information

NPI: 1871590604
Provider Name (Legal Business Name): KEITH DAVID ANDERSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

11292 HADLEY ST
OVERLAND PARK KS
66210-2410
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax: 816-922-3317
Mailing address:
  • Phone: 913-722-6456
  • Fax: 816-922-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number10383
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: