Healthcare Provider Details

I. General information

NPI: 1770194672
Provider Name (Legal Business Name): MONICA V HOBBS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA V GRZELAK PHARMD

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 W BUSINESS US HIGHWAY 60
DEXTER MO
63841-2701
US

IV. Provider business mailing address

904 W BUSINESS US HIGHWAY 60
DEXTER MO
63841-2701
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-7452
  • Fax:
Mailing address:
  • Phone: 573-624-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016030196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: