=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114296167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT MITCHELL POELL RPH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2011
-----------------------------------------------------
Last Update Date | 12/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12601 PFLUMM RD
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66213-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-764-3471
-----------------------------------------------------
Fax | 913-764-5098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12601 PFLUMM RD
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66213-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-764-3471
-----------------------------------------------------
Fax | 913-764-5098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10494
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------