Healthcare Provider Details

I. General information

NPI: 1861891707
Provider Name (Legal Business Name): KEVIN MICHAEL APPELBAUM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 S NATIONAL AVE APARTMENT 2704
SPRINGFIELD MO
65810-2687
US

IV. Provider business mailing address

2640 E SUNSHINE ST
SPRINGFIELD MO
65804-2045
US

V. Phone/Fax

Practice location:
  • Phone: 314-740-3128
  • Fax:
Mailing address:
  • Phone: 314-740-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014026368
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: