Provider Demographics
NPI:1740561026
Name:KISSEL, ZACHARY MATTHEW (PHARM D)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:MATTHEW
Last Name:KISSEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2702
Mailing Address - Country:US
Mailing Address - Phone:913-307-3057
Mailing Address - Fax:913-307-3063
Practice Address - Street 1:4016 W 95TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2702
Practice Address - Country:US
Practice Address - Phone:913-307-3057
Practice Address - Fax:913-307-3063
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14745183500000X
MO2008016514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist