Provider Demographics
NPI:1134855786
Name:FROESCHL, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:FROESCHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1819
Mailing Address - Country:US
Mailing Address - Phone:913-424-9190
Mailing Address - Fax:
Practice Address - Street 1:1785 S MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2611
Practice Address - Country:US
Practice Address - Phone:913-390-9892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021035902183500000X
KS1-104001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist