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General NPI Number Information
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NPI Number | 1265649388
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Entity Type | Organization
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Legal Business Name | SAMUEL U. RODGERS HEALTH CENTER
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 825 EUCLID AVE
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City | KANSAS CITY
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State | MO
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Zip | 64124
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Country | US
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Telephone | 816-889-4652
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Fax | 816-842-6227
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Provider Business Mailing Address
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Address Line | 825 EUCLID AVE
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City | KANSAS CITY
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State | MO
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Zip | 64124-2323
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Country | US
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Telephone | 816-889-4652
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Fax | 816-842-6227
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | MR. MAYBELLE M BOWENS
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Credential | BS
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Telephone | 816-889-4652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 28254
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License Number State | MO
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