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General NPI Number Information
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NPI Number | 1033611207
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Entity Type | Individual
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Provider Name | THOMAS JOHN ZLATOHLAVEK PHARM D
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Gender | Male
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 400 S BROADWAY
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City | OAK GROVE
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State | MO
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Zip | 64075-6140
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Country | US
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Telephone | 816-625-3796
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Fax |
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Provider Business Mailing Address
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Address Line | 5610 GOODMAN ST
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City | MERRIAM
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State | KS
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Zip | 66202-2236
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Country | US
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Telephone | 319-573-9208
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16261
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License Number State | KS
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