Healthcare Provider Details

I. General information

NPI: 1225198468
Provider Name (Legal Business Name): COSENTINO ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 SW GREENWICH DR
LEES SUMMIT MO
64082-4426
US

IV. Provider business mailing address

3901 W 83RD ST
PRAIRIE VILLAGE KS
66208-5308
US

V. Phone/Fax

Practice location:
  • Phone: 816-744-2104
  • Fax: 816-744-2106
Mailing address:
  • Phone: 913-749-1511
  • Fax: 913-905-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2003020266
License Number StateMO

VIII. Authorized Official

Name: FRANK WOLFF
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 913-749-1511