Provider Demographics
NPI:1396172300
Name:STITES, GREGORY (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:STITES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 CARTER RD
Mailing Address - Street 2:APT 502
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7874
Mailing Address - Country:US
Mailing Address - Phone:785-393-0995
Mailing Address - Fax:
Practice Address - Street 1:13610 CARTER RD
Practice Address - Street 2:APT 502
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-7874
Practice Address - Country:US
Practice Address - Phone:785-393-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist