Individual
SHANNON BETH NELSON-BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
125 W KARSCH BLVD, FARMINGTON, MO 63640-2156
(573) 756-5425
Mailing address
31835 STATE HIGHWAY 25, ADVANCE, MO 63730-8364
(573) 270-7671
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
044986
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044986
MISSOURI BOARD OF PHARMCY
MO
Enumeration date
01/27/2021
Last updated
01/27/2021
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