Healthcare Provider Details

I. General information

NPI: 1831294792
Provider Name (Legal Business Name): BUFFALO PROFESSIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/19/2025
Certification Date:
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005240
License Number StateMO

VIII. Authorized Official

Name: AL NYBERG
Title or Position: PRESIDENT AND CHIEF RPH
Credential:
Phone: 417-345-6500