Individual
DIANE LEIGH SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 W 2ND ST, MOUNTAIN VIEW, MO 65548-8590
(417) 934-2023
Mailing address
124 W 2ND ST, MOUNTAIN VIEW, MO 65548-8590
(417) 934-2023
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2010027515
MO
Other
Enumeration date
08/25/2020
Last updated
08/25/2020
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