Provider Demographics
NPI:1598786568
Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Entity Type:Organization
Organization Name:CURATORS OF THE UNIVERSITY OF MISSOURI
Other - Org Name:UMKC STUDENT HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBBA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:816-235-6103
Mailing Address - Street 1:4825 TROOST AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2030
Mailing Address - Country:US
Mailing Address - Phone:816-235-6103
Mailing Address - Fax:816-235-6565
Practice Address - Street 1:4825 TROOST AVE
Practice Address - Street 2:STE 115
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2030
Practice Address - Country:US
Practice Address - Phone:816-235-6103
Practice Address - Fax:816-235-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040217473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2635639OtherNCPDP PROVIDER IDENTIFICATION NUMBER