Basic Information
Provider Information
NPI: 1003138835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPIEGEL
FirstName: JEFFREY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD., RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14209 MACKEY ST
Address2:  
City: OVERLAND PARK
State: KS
PostalCode: 662232568
CountryCode: US
TelephoneNumber: 9138517007
FaxNumber:  
Practice Location
Address1: 7836 STATE AVE
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661122417
CountryCode: US
TelephoneNumber: 9132996016
FaxNumber: 9132991735
Other Information
ProviderEnumerationDate: 02/21/2010
LastUpdateDate: 02/21/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X1-13199KSY Pharmacy Service ProvidersPharmacist 

No ID Information.


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