Provider Demographics
NPI:1205325537
Name:AST, TRICIA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:AST
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 1:11452 S NORTHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6500
Mailing Address - Country:US
Mailing Address - Phone:712-540-5164
Mailing Address - Fax:
Practice Address - Street 1:10303 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1805
Practice Address - Country:US
Practice Address - Phone:913-642-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14876183500000X
IA21219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21219OtherPHARMACIST LICENSE NUMBER
KS1-14876OtherPHARMACIST LICENSE NUMBER