Provider Demographics
NPI:1215037809
Name:MOYER, KENNETH CHRIS (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHRIS
Last Name:MOYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3718
Mailing Address - Country:US
Mailing Address - Phone:913-341-7244
Mailing Address - Fax:
Practice Address - Street 1:7222 W 80TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3718
Practice Address - Country:US
Practice Address - Phone:913-341-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1232420001Medicare ID - Type Unspecified