Healthcare Provider Details

I. General information

NPI: 1316007594
Provider Name (Legal Business Name): MARY ANN SCANLON-BECVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANN SCANLON

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SIJEN AVE 509TH MEDICAL GROUP
WHITEMAN AFB MO
65305-1269
US

IV. Provider business mailing address

405 N BYNUM RD
LONE JACK MO
64070-9588
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax:
Mailing address:
  • Phone: 816-697-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40871
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: