=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053002543
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE ALEXANDRA MROSAK PHARM D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 E LEXINGTON ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64085-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-776-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 S SKYLINE DR
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64068-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-517-8119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 1-100370
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2022044987
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------