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General NPI Number Information
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NPI Number | 1518392034
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Entity Type | Individual
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Provider Name | WALTER B AGBOR PHARM D,MS
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Gender | Male
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 2301 RUNNING HORSE RD 7573924934
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City | PLATTE CITY
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State | MO
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Zip | 64079-7703
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Country | US
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Telephone | 757-392-4934
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 RUNNING HORSE RD 7573924934
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City | PLATTE CITY
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State | MO
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Zip | 64079-7703
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Country | US
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Telephone | 757-392-4934
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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 | 2013024736
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 116177
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License Number State | KS
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