Healthcare Provider Details

I. General information

NPI: 1710681119
Provider Name (Legal Business Name): CASSIE LYN MANESS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S SPRINGFIELD AVE STE A
BOLIVAR MO
65613-2512
US

IV. Provider business mailing address

50 BIG TREE TRL
BUFFALO MO
65622-4193
US

V. Phone/Fax

Practice location:
  • Phone: 417-328-4700
  • Fax: 855-662-4032
Mailing address:
  • Phone: 417-894-7770
  • Fax: 855-662-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2019036894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: