Individual
KATHY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
340 KELLEY PKWY STE D, MEXICO, MO 65265-3811
(573) 567-7077
Mailing address
340 KELLEY PKWY STE D, MEXICO, MO 65265-3811
(573) 567-7077
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
040528
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040528
PHARMACIST LICENSE
MO
Enumeration date
09/06/2017
Last updated
07/21/2022
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