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)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
Direct Messaging Address activeliferx@att.net Direct

Other providers in Overland Park, KS

All providers in Overland Park, KS · Community/Retail Pharmacy in Kansas

Sources for this page

Verify at the official NPI Registry.