Healthcare Provider Details

I. General information

NPI: 1154698272
Provider Name (Legal Business Name): KELLI ANN KINZER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S MADISON ST STE S
WEBB CITY MO
64870-2426
US

IV. Provider business mailing address

501 S MADISON ST STE S
WEBB CITY MO
64870-2426
US

V. Phone/Fax

Practice location:
  • Phone: 417-673-2200
  • Fax: 417-673-2212
Mailing address:
  • Phone: 417-673-2200
  • Fax: 417-673-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044271
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11298
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-11674
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: