Healthcare Provider Details

I. General information

NPI: 1558800888
Provider Name (Legal Business Name): ALVIN NYBERG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W DALLAS ST
BUFFALO MO
65622-7635
US

IV. Provider business mailing address

PO BOX 710
BUFFALO MO
65622-0710
US

V. Phone/Fax

Practice location:
  • Phone: 417-345-6500
  • Fax: 417-345-6565
Mailing address:
  • Phone: 417-345-6500
  • Fax: 417-345-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: