Individual
JANA NORTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 328-6424
Mailing address
903 E 438TH RD, BOLIVAR, MO 65613-8237
(417) 770-7101
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH044220
MO
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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