Provider Demographics
NPI:1679872071
Name:STOTT, MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7201
Mailing Address - Country:US
Mailing Address - Phone:816-265-6134
Mailing Address - Fax:816-265-6136
Practice Address - Street 1:900 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-7201
Practice Address - Country:US
Practice Address - Phone:816-265-6134
Practice Address - Fax:816-265-6136
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007025734183500000X
KS1-14585183500000X
NE11853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist