Provider Demographics
NPI:1336736347
Name:ORTHEL, ALICIA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
Last Name:ORTHEL
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 1:4240 BLUE RIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1703
Mailing Address - Country:US
Mailing Address - Phone:816-256-8878
Mailing Address - Fax:816-256-8882
Practice Address - Street 1:4240 BLUE RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1703
Practice Address - Country:US
Practice Address - Phone:816-256-8878
Practice Address - Fax:816-256-8882
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14486183500000X
MO2020007310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist