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General NPI Number Information
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NPI Number | 1316936552
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Entity Type | Organization
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Legal Business Name | STARK APOTHECARY
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12200 W 106TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2300
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Country | US
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Telephone | 913-541-5700
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Fax | 913-541-6028
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Provider Business Mailing Address
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Address Line | 12200 W 106TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2300
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Country | US
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Telephone | 913-541-5700
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Fax | 913-541-6028
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MRS. MARY VANE KENSHALO
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Credential | RPH.
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Telephone | 913-541-5700
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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 | 9415
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License Number State | KS
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