Individual
DR. IAN THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1711 N MORLEY ST, MOBERLY, MO 65270-3630
(660) 263-4187
Mailing address
4525 WATERLOO DR, COLUMBIA, MO 65202-1162
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2020031426
MO
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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