Healthcare Provider Details

I. General information

NPI: 1174879043
Provider Name (Legal Business Name): STACEY AKEMI KWAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

IV. Provider business mailing address

431 KINGS RDG
LIBERTY MO
64068-1110
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5215
  • Fax:
Mailing address:
  • Phone: 816-407-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number045238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: