Healthcare Provider Details

I. General information

NPI: 1518567197
Provider Name (Legal Business Name): CAROLE FICKEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 WALTON WAY
RICHMOND MO
64085-2193
US

IV. Provider business mailing address

5908 NW 78TH TER
KANSAS CITY MO
64151-4429
US

V. Phone/Fax

Practice location:
  • Phone: 816-776-8577
  • Fax: 816-776-8764
Mailing address:
  • Phone: 816-916-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2001018150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: