Healthcare Provider Details

I. General information

NPI: 1265374441
Provider Name (Legal Business Name): GEORGIA UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGIA KEISER

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E MAIN ST
ADRIAN MO
64720-8201
US

IV. Provider business mailing address

21 E MAIN ST
ADRIAN MO
64720-8201
US

V. Phone/Fax

Practice location:
  • Phone: 816-297-8833
  • Fax: 816-297-2900
Mailing address:
  • Phone: 816-297-8833
  • Fax: 816-297-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044521
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: