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General NPI Number Information
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NPI Number | 1528168689
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Entity Type | Individual
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Provider Name | LISA KAY UMFLEET RPH
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 1131 N DESLOGE DR
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City | DESLOGE
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State | MO
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Zip | 63601-2936
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Country | US
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Telephone | 573-431-6777
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Fax | 573-431-3833
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Provider Business Mailing Address
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Address Line | 1131 N DESLOGE DR
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City | DESLOGE
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State | MO
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Zip | 63601-2936
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Country | US
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Telephone | 573-431-6677
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Fax | 573-431-3833
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 21600062
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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 | 044520
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License Number State | MO
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