Provider Demographics
NPI:1235747601
Name:ALLEN, CONNOR MICHAEL
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:ALLEN
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 1:17002 NE 121ST TER
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7449
Mailing Address - Country:US
Mailing Address - Phone:816-810-2590
Mailing Address - Fax:
Practice Address - Street 1:17002 NE 121ST TER
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7449
Practice Address - Country:US
Practice Address - Phone:816-810-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019037447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist