Provider Demographics
NPI:1649545971
Name:ABBOTT, VICKIE LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 BLUE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2640
Mailing Address - Country:US
Mailing Address - Phone:913-217-2052
Mailing Address - Fax:
Practice Address - Street 1:19040 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7004
Practice Address - Country:US
Practice Address - Phone:816-200-2002
Practice Address - Fax:816-200-2021
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13560183500000X
MO043744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist