Healthcare Provider Details

I. General information

NPI: 1962096107
Provider Name (Legal Business Name): JUSTIN SKEENS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SW WARD RD
LEES SUMMIT MO
64081-2445
US

IV. Provider business mailing address

5240 W 150TH TER
LEAWOOD KS
66224-3426
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-2200
  • Fax:
Mailing address:
  • Phone: 816-868-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021006325
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: