Provider Demographics
NPI:1881940609
Name:VANDER VOORT, GERRIT SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERRIT
Middle Name:SCOTT
Last Name:VANDER VOORT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14328 W 116TH TER
Mailing Address - Street 2:APT. 3013
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3686
Mailing Address - Country:US
Mailing Address - Phone:913-633-7675
Mailing Address - Fax:
Practice Address - Street 1:1453 E 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2854
Practice Address - Country:US
Practice Address - Phone:913-538-5019
Practice Address - Fax:913-538-5025
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist