MEDICARE: JEREMY VANDERVOORT PHARMD

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	1-14564	KS

General Provider Information

NPI Number	:	1205431913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY VANDERVOORT PHARMD

Provider Business Mailing Address
First Line	:	2288 W TRAIL DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-5003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1785 S MUR LEN RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-2611
Country	:	US
Telephone Number	:	913-390-9892
Fax Number	:	913-390-9562

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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