Provider Demographics
NPI:1033795190
Name:STONE, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 W 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4834
Mailing Address - Country:US
Mailing Address - Phone:913-485-1433
Mailing Address - Fax:
Practice Address - Street 1:14023 W 113TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66215-4834
Practice Address - Country:US
Practice Address - Phone:913-485-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10577183500000X
MO041030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist