Provider Demographics
NPI:1689981789
Name:FORESEE, BRENTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENTON
Middle Name:
Last Name:FORESEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 METCALF AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2810
Mailing Address - Country:US
Mailing Address - Phone:913-749-1511
Mailing Address - Fax:
Practice Address - Street 1:13180 METCALF AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2810
Practice Address - Country:US
Practice Address - Phone:913-749-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15031183500000X
MO2010026496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist