Healthcare Provider Details

I. General information

NPI: 1265429104
Provider Name (Legal Business Name): SHERYL L SMITH CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 FREDERICK AVE BENDERS PRESCRIPTION SHOP
SAINT JOSEPH MO
64506-3020
US

IV. Provider business mailing address

207 S 30TH ST
SAINT JOSEPH MO
64501-3336
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-1668
  • Fax: 816-279-6425
Mailing address:
  • Phone: 816-232-8645
  • Fax: 816-279-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2002029470
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number16-01686
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: