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1811536683
ACTIVE LIFESTYLE PHARMACY LLC
OVERLAND PARK, KS
NPI
1811536683
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Entity Type
Organization
Authorized Contact
JACOB M LICKTEIG
President
785-760-3839
Organization Subpart ?
No
Primary Taxonomy
3336C0003X Pharmacy, Community/Retail Pharmacy
Enumeration Date
2019-12-27
Last Update Date
2019-12-27
Business Address
ACTIVE LIFESTYLE PHARMACY LLC
7800 FOSTER ST
OVERLAND PARK, KS 66204-2955
Phone number: 913-730-8731
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Mailing Address
ACTIVE LIFESTYLE PHARMACY LLC
7800 FOSTER ST
OVERLAND PARK, KS 66204-2955
Phone number: 913-730-8731
Copy
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