Individual
JAMIE PROKUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
29936 JULY RD, LA PLATA, MO 63549-3129
(660) 332-4456
Mailing address
29936 JULY RD, LA PLATA, MO 63549-3129
(660) 332-4456
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
042461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600133003
—
MO
Enumeration date
02/17/2011
Last updated
02/17/2011
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