Provider Demographics
NPI:1134118359
Name:STARK APOTHECARY
Entity Type:Organization
Organization Name:STARK APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:POELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-541-5431
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-541-5431
Mailing Address - Fax:913-541-6022
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-541-5431
Practice Address - Fax:913-541-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5375070002Medicare ID - Type Unspecified