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NPI Code Detail

MEDICARE: BRAD J KRAUSE RPH

MEDICARE: BRAD J KRAUSE RPH
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
1183500000XPharmacist042105MO

General Provider Information

NPI Number : 1912502493
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD J KRAUSE RPH
Provider Business Mailing Address
First Line : 57 L ST
Second Line :
City : LAKE LOTAWANA
State : MO
Zip : 64086-9440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1900 E LANGSFORD RD
Second Line :
City : LEES SUMMIT
State : MO
Zip : 64063-3600
Country : US
Telephone Number : 816-554-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 12/02/2020

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