Provider Demographics
NPI:1255983318
Name:AMELUNKE, REBECCA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:AMELUNKE
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 1:110 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8714
Mailing Address - Country:US
Mailing Address - Phone:816-304-7173
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?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018039376183500000X
KS1-107482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist