Individual
MR. SAMUEL LEE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2100 N MAIN AVE, MOUNTAIN GROVE, MO 65711-2438
(417) 926-4129
(417) 926-7578
Mailing address
RR 1 BOX 425, VANZANT, MO 65768-9704
(417) 948-2383
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2003029964
MO
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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