Healthcare Provider Details

I. General information

NPI: 1073359600
Provider Name (Legal Business Name): BORDEN EDGAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

5004 STONE MOUNTAIN PKWY
COLUMBIA MO
65201-2913
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-0500
  • Fax:
Mailing address:
  • Phone: 573-569-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number2020020023
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: