Healthcare Provider Details

I. General information

NPI: 1841567054
Provider Name (Legal Business Name): JENNIFER JAYNE CONRAD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW WARD RD
LEES SUMMIT MO
64081-2445
US

IV. Provider business mailing address

330 SW WARD RD
LEES SUMMIT MO
64081-2445
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-7732
  • Fax: 816-246-7702
Mailing address:
  • Phone: 816-246-7732
  • Fax: 816-246-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42355
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: