Provider Demographics
NPI:1336558972
Name:HESS, PAUL
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HESS
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 1:16611 E 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-1922
Mailing Address - Country:US
Mailing Address - Phone:816-833-8629
Mailing Address - Fax:816-833-8634
Practice Address - Street 1:16611 E 23RD ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1922
Practice Address - Country:US
Practice Address - Phone:816-833-8629
Practice Address - Fax:816-833-8634
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008020965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008020965OtherPHARMACIST LICENSE