Healthcare Provider Details

I. General information

NPI: 1235617978
Provider Name (Legal Business Name): KANDISE BUIE PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W REPUBLIC RD
SPRINGFIELD MO
65807-5730
US

IV. Provider business mailing address

1333 N OPPORTUNITY AVE
REPUBLIC MO
65738-7526
US

V. Phone/Fax

Practice location:
  • Phone: 417-891-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2018028838
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2018028838
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2018028838
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: