Individual
DANA COVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
212 HOSPITAL LN STE 102, PERRYVILLE, MO 63775-4204
(573) 547-4960
(573) 547-6540
Mailing address
925 LINDMARK DR, WENTZVILLE, MO 63385-6878
(573) 330-4369
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051287027
IL
183500000X
Pharmacist
Primary
2001028207
MO
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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