Organization
NYBERG PHARMACY INC
Active
Other names
NYBERG PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DWIGHT NYBERG RPH (OWNER/PIC)
(417) 345-2321
Entity
Organization
Contact information
Practice address
315 S ASH, BUFFALO, MO 65622-0860
(417) 345-2321
(417) 345-8837
Mailing address
PO BOX 860, BUFFALO, MO 65622-0860
(417) 345-2321
(417) 345-8837
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004441
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2605129
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600053904
—
MO
Enumeration date
08/18/2006
Last updated
01/27/2012
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