Facts
- Status
- A
- Credential
- Pharm.D.
- Type
- Individual
- Enumeration date
- 2007-03-28
- Last updated
- 2007-07-08
Specialties
Licenses
- License MO
- 2002027580
Location
- Practice location
- 605A W 12TH ST
- City
- LAMAR MO
- Postal code
- 647591703
- Phone
- 417-682-5838
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.