Provider Demographics
NPI:1134135999
Name:SMOCK, NICK R (PHARM D, MBA)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:R
Last Name:SMOCK
Suffix:
Gender:M
Credentials:PHARM D, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1575 UNIVERSAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64120-2166
Mailing Address - Country:US
Mailing Address - Phone:816-245-5700
Mailing Address - Fax:816-245-5702
Practice Address - Street 1:2327 NE SMOKEY HILL DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-7019
Practice Address - Country:US
Practice Address - Phone:816-246-2047
Practice Address - Fax:816-246-2047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO413871835P1200X
KS111811835P1200X
AR83961835P1200X
TX358511835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy