Provider Demographics
NPI:1760582027
Name:ESTES, SHIRLEY DIANE
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DIANE
Last Name:ESTES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:DIANE
Other - Last Name:TROUTWINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:101 W 61ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1455
Mailing Address - Country:US
Mailing Address - Phone:816-861-4700
Mailing Address - Fax:816-922-4736
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:816-922-4736
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO029374OtherPHARMACIST LICENSE NUMBER