Provider Demographics
NPI:1518176882
Name:DIETRICH, DOUGLAS K (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:DIETRICH
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 1:4113 SW LAHARVE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4697
Mailing Address - Country:US
Mailing Address - Phone:816-537-5391
Mailing Address - Fax:
Practice Address - Street 1:6860 W 115TH ST STE 150
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2400
Practice Address - Country:US
Practice Address - Phone:913-253-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist