MEDICARE: MRS. LISA MARIE SOBBA R.PH.

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	044948	MO

General Provider Information

NPI Number	:	1558658583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE SOBBA R.PH.

Provider Business Mailing Address
First Line	:	3405 NE 48TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3519
Country	:	US
Telephone Number	:	816-260-3125
Fax Number	:

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

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/28/2011

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