Healthcare Provider Details

I. General information

NPI: 1033166517
Provider Name (Legal Business Name): KIEFER THOMPSON PHARMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W YOAKUM AVE
CHAFFEE MO
63740-1138
US

IV. Provider business mailing address

211 W YOAKUM AVE
CHAFFEE MO
63740-1138
US

V. Phone/Fax

Practice location:
  • Phone: 573-887-3622
  • Fax: 573-887-3309
Mailing address:
  • Phone: 573-887-3622
  • Fax: 573-887-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN THOMAS KIEFER
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 573-887-3622