MEDICARE: RAYMOND KIRK

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	183500000X	Pharmacist	044201	MO

General Provider Information

NPI Number	:	1093576951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND KIRK

Provider Business Mailing Address
First Line	:	119 E MAIN ST
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-1228
Country	:	US
Telephone Number	:	417-476-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 E MAIN ST
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-1228
Country	:	US
Telephone Number	:	417-476-2828
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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Directions to “ RAYMOND KIRK ” Practice Location

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