MEDICARE: WHEEL'S PHARMACY

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	3336C0003X	Community/Retail Pharmacy	005254	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2048939	OTHER		PK

General Provider Information

NPI Number	:	1174538706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEEL'S PHARMACY

Provider Business Mailing Address
First Line	:	2450 GRAND BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2535
Country	:	US
Telephone Number	:	816-471-2017
Fax Number	:	816-222-0570

Provider Business Practice Location Address
First Line	:	2450 GRAND BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2535
Country	:	US
Telephone Number	:	816-749-4947
Fax Number	:	816-749-4947

Authorized Official
Title or Position	:	OWNER
Name	:	JEROME WHEELER
Credential	:
Telephone Number	:	816-260-6346

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/14/2015

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Directions to “WHEEL'S PHARMACY ” Practice Location

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