Healthcare Provider Details

I. General information

NPI: 1518447580
Provider Name (Legal Business Name): MADISON MICHELLE LOEHR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NW VICTORIA DR STE B
LEES SUMMIT MO
64086-4709
US

IV. Provider business mailing address

1350 S ELLSWORTH RD APT 2032
MESA AZ
85209-2804
US

V. Phone/Fax

Practice location:
  • Phone: 855-937-7273
  • Fax:
Mailing address:
  • Phone: 712-346-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023416
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2020004497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: