MEDICARE: MISS CHRISTINA MARIE KOURY PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2011023750	MO
2	183500000X	Pharmacist	1-15321	KS

General Provider Information

NPI Number	:	1114280005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINA MARIE KOURY PHARM D

Provider Business Mailing Address
First Line	:	8509 STATE LINE RD
Second Line	:	T-1436
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2723
Country	:	US
Telephone Number	:	816-444-0019
Fax Number	:	816-410-2981

Provider Business Practice Location Address
First Line	:	8509 STATE LINE RD
Second Line	:	T-1436
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2723
Country	:	US
Telephone Number	:	816-444-0019
Fax Number	:	816-410-2981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	06/17/2012

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