Provider Demographics
NPI:1992890644
Name:HOWARD STARK PROFESSIONAL PHARMACY
Entity type:Organization
Organization Name:HOWARD STARK PROFESSIONAL PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-6611
Mailing Address - Street 1:6675 HOLMES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1164
Mailing Address - Country:US
Mailing Address - Phone:816-333-6611
Mailing Address - Fax:816-444-6450
Practice Address - Street 1:6675 HOLMES RD STE 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1164
Practice Address - Country:US
Practice Address - Phone:816-333-6611
Practice Address - Fax:816-444-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO25513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600745707Medicaid