Healthcare Provider Details

I. General information

NPI: 1003426768
Provider Name (Legal Business Name): DOUGLAS KLEIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 NE DOUGLAS ST
LEES SUMMIT MO
64086-4602
US

IV. Provider business mailing address

829 SW STABLEWOOD CT
LEES SUMMIT MO
64081-3272
US

V. Phone/Fax

Practice location:
  • Phone: 816-607-5152
  • Fax:
Mailing address:
  • Phone: 816-522-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0044202
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: