Healthcare Provider Details

I. General information

NPI: 1063018620
Provider Name (Legal Business Name): AMANDA ZUNGURA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E LANGSFORD RD
LEES SUMMIT MO
64063-3600
US

IV. Provider business mailing address

1028 SW CROSSING DR
LEES SUMMIT MO
64081-3243
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-9500
  • Fax: 816-554-1538
Mailing address:
  • Phone: 417-235-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014024147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: