# LETASSY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356551592
- **Authorized official:** BERNARD R LETASSY RPH. (PHARMACIST)
- **Authorized official phone:** (573) 785-8421

## Contact information

- **Practice address:** 1014 W PINE ST, POPLAR BLUFF, MO 63901-4840
- **Practice address phone:** (573) 785-8421
- **Practice address fax:** (573) 785-3348
- **Mailing address:** 1014 W PINE ST, POPLAR BLUFF, MO 63901-4840
- **Mailing address phone:** (573) 785-8421
- **Mailing address fax:** (573) 785-3348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 026011 | MO | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 08/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2618568 | NAPD | MO |
| 05 | — | 601504202 | — | MO |