Healthcare Provider Details

I. General information

NPI: 1659971349
Provider Name (Legal Business Name): SOO TONG YAP RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W FOXWOOD DR
RAYMORE MO
64083-9380
US

IV. Provider business mailing address

2015 W FOXWOOD DR
RAYMORE MO
64083-9380
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-2975
  • Fax: 816-331-0742
Mailing address:
  • Phone: 816-331-2975
  • Fax: 816-331-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-12959
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044999
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: