Individual
JONATHAN DAVID LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 HWY 165, BRANSON, MO 65616-3464
(417) 339-3996
Mailing address
354 MAYNARD RD, NIXA, MO 65714-7267
(417) 693-3266
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2022343890
MO
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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