Healthcare Provider Details

I. General information

NPI: 1023594124
Provider Name (Legal Business Name): MICHALA FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NE SYCAMORE ST # A
LEES SUMMIT MO
64086-9578
US

IV. Provider business mailing address

6 NE SYCAMORE ST # A
LEES SUMMIT MO
64086-9578
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4222
  • Fax: 816-246-4223
Mailing address:
  • Phone: 816-246-4222
  • Fax: 816-246-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016002118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: