Healthcare Provider Details

I. General information

NPI: 1679613459
Provider Name (Legal Business Name): BRITT N HASSELBRING RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 S MAIN ST
CONCORDIA MO
64020-9602
US

IV. Provider business mailing address

728 S MAIN ST P.O. BOX 630
CONCORDIA MO
64020-9602
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-2519
  • Fax: 660-463-7732
Mailing address:
  • Phone: 660-463-2519
  • Fax: 660-463-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040277
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: