Healthcare Provider Details

I. General information

NPI: 1801671250
Provider Name (Legal Business Name): JACOB TRITTEN WRIGHT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416B S MAPLE ST
ELDON MO
65026-1812
US

IV. Provider business mailing address

PO BOX 1560
OSAGE BEACH MO
65065-1560
US

V. Phone/Fax

Practice location:
  • Phone: 573-557-2231
  • Fax: 573-392-5808
Mailing address:
  • Phone: 573-557-2231
  • Fax: 573-392-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016027150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: