Provider Demographics
NPI:1699087155
Name:SKELTON, HOLLY SHARZAD (PHARM D)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:SHARZAD
Last Name:SKELTON
Suffix:
Gender:F
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 1:255 NW VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4709
Mailing Address - Country:US
Mailing Address - Phone:816-875-5111
Mailing Address - Fax:
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:SUITE 120
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-4879
Practice Address - Fax:816-943-4882
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114889OtherPHARMACIST
NE14333OtherPHARMACIST
IA50207OtherPHARMACIST
VA02002216138OtherPHARMACIST
WARP0010157OtherPHARMACIST
ORRPH0016519OtherPHARMACIST
MO2010023011OtherPHARMACIST
PANP000416OtherPHARMACIST
ARPD13927OtherPHARMACIST