Provider Demographics
NPI:1891464939
Name:WITTHAR, HADEI MADISON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HADEI
Middle Name:MADISON
Last Name:WITTHAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN ST UNIT 1801
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2479
Mailing Address - Country:US
Mailing Address - Phone:816-876-7209
Mailing Address - Fax:
Practice Address - Street 1:13000 S US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2515
Practice Address - Country:US
Practice Address - Phone:816-769-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021031389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021031389OtherMISSOURI BOARD OF PHARMACY