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General NPI Number Information
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NPI Number | 1033588066
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Entity Type | Individual
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Provider Name | MANNIE TRUJILLO PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 1000 NE SAM WALTON LN
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City | LEES SUMMIT
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State | MO
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Zip | 64086-8426
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Country | US
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Telephone | 214-673-0941
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 NW SAM WALTON LN.
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City | LEE'S SUMMIT
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State | MO
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Zip | 64086
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Country | US
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Telephone | 214-673-0941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 1-16984
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 46176
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 2014042861
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License Number State | MO
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