Provider Demographics
NPI:1174049183
Name:GLADBACK, CHELSEA JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JEAN
Last Name:GLADBACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-7868
Mailing Address - Country:US
Mailing Address - Phone:417-689-2299
Mailing Address - Fax:
Practice Address - Street 1:9000 NE 103RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-7868
Practice Address - Country:US
Practice Address - Phone:417-689-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15601183500000X
MO2017025912183500000X
KS1-103154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist