Healthcare Provider Details

I. General information

NPI: 1982525564
Provider Name (Legal Business Name): MAKAELA DAWN DAVID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N OAKLAND AVE
BOLIVAR MO
65613-3099
US

IV. Provider business mailing address

218 E MONROE ST
WALNUT GROVE MO
65770-8413
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-6000
  • Fax:
Mailing address:
  • Phone: 417-880-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026018147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: