Healthcare Provider Details

I. General information

NPI: 1417764739
Provider Name (Legal Business Name): KAYSE C STARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E GRAND ST
SPRINGFIELD MO
65807-1447
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8430
  • Fax:
Mailing address:
  • Phone: 636-224-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024037845
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: