Active Lifestyle Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Overland Park, KS
NPI 1811536683 · NPPES record last updated Dec 27, 2019
Key facts
- NPI
- 1811536683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ACTIVE LIFESTYLE PHARMACY LLC
- Practice address
- 7800 Foster St
Overland Park, KS 66204-2955 - Phone
- (913) 730-8731
- Fax
- (844) 842-0014
- NPI assigned
- Dec 27, 2019
- Organization subpart
- No
Authorized official
- Name
- Jacob M Lickteig
- Title
- President
- Phone
- (785) 760-3839
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
7800 Foster St
Overland Park, KS 66204-2955
Mailing address
7800 Foster St
Overland Park, KS 66204-2955
Phone (913) 730-8731
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | activeliferx@att.net | Direct |
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All providers in Overland Park, KS · Community/Retail Pharmacy in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.