Healthcare Provider Details

I. General information

NPI: 1982531901
Provider Name (Legal Business Name): NANCY JACKSON CANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY JACKSON KUOFIE

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W KANSAS ST
LIBERTY MO
64068-2060
US

IV. Provider business mailing address

3025 NW 63RD ST
KANSAS CITY MO
64151-7823
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-0035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2015034906
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-17165
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: