MEDICARE: DR. JILL ANDREA SELLERS BSPHARM, PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	043683	MO
2	1835P1200X	Pharmacotherapy Pharmacist	043683	MO

General Provider Information

NPI Number	:	1013296631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL ANDREA SELLERS BSPHARM, PHARMD

Provider Business Mailing Address
First Line	:	4185 E WILSHIRE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3407
Country	:	US
Telephone Number	:	218-209-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 E SUNSHINE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-2820
Country	:	US
Telephone Number	:	417-889-7898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2011
Last Update Date	:	08/13/2011

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