Provider Demographics
NPI:1417559352
Name:MORASCH, MARY D (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:MORASCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 SW CEDAR HILL LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2243
Mailing Address - Country:US
Mailing Address - Phone:816-572-3454
Mailing Address - Fax:
Practice Address - Street 1:141 N DEAN AVE
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8398
Practice Address - Country:US
Practice Address - Phone:816-425-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-11449OtherKANSAS STATE LICENSE NUMBER
MO040255OtherMISSOURI STATE LICENSE NUMBER
MO040255OtherSTATE PHARMACIST LICENSE