Provider Demographics
NPI:1093131500
Name:NYBERG, CHESSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHESSA
Middle Name:
Last Name:NYBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E PORTE CIMI PAS ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2922
Mailing Address - Country:US
Mailing Address - Phone:417-343-3998
Mailing Address - Fax:
Practice Address - Street 1:410 E PORTE CIMI PAS ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2922
Practice Address - Country:US
Practice Address - Phone:417-343-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090253771835P0018X
IL051.2945531835P0018X
KS1-154361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist