Healthcare Provider Details

I. General information

NPI: 1063423572
Provider Name (Legal Business Name): KANSAS CITY CANCER CENTERS EAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 NE GOODVIEW CIR
LEES SUMMIT MO
64064-1996
US

IV. Provider business mailing address

PO BOX 911277
DALLAS TX
75391-1277
US

V. Phone/Fax

Practice location:
  • Phone: 816-350-5844
  • Fax: 816-503-4070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2003007587
License Number StateMO

VIII. Authorized Official

Name: ALISON FETTER
Title or Position: MANGER OF PHARMACY SERVICES
Credential: PHARMD
Phone: 913-541-4651