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Individual

DANIELLE R FAIRBANKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
101 INDUSTRIAL PARK DRIVE, HOLLISTER, MO 65672
(417) 336-6901
Mailing address
163 OSPREY LANE, BLUE EYE, MO 65611
(402) 995-9506

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
14591
NE
183500000X
Pharmacist
Primary
2019044157
MO
183500000X
Pharmacist
22336
IA

Other

Enumeration date
03/12/2018
Last updated
12/17/2022
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