Healthcare Provider Details

I. General information

NPI: 1245834985
Provider Name (Legal Business Name): ANTHONY J SPALITTO III PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E OHIO ST
CLINTON MO
64735-2432
US

IV. Provider business mailing address

1501 E OHIO ST
CLINTON MO
64735-2432
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-0707
  • Fax:
Mailing address:
  • Phone: 606-890-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2019032268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: