Provider Demographics
NPI:1679858336
Name:WIER, KENNETH KIRK (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KIRK
Last Name:WIER
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 1:208 NW CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1510
Mailing Address - Country:US
Mailing Address - Phone:816-810-3441
Mailing Address - Fax:816-220-3623
Practice Address - Street 1:208 NW CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-1510
Practice Address - Country:US
Practice Address - Phone:816-810-3441
Practice Address - Fax:816-220-3623
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist