Healthcare Provider Details

I. General information

NPI: 1275817884
Provider Name (Legal Business Name): MICHAEL CHARLES RIMAR R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST
JOPLIN MO
64804-2045
US

IV. Provider business mailing address

6397 FILLY LN
JOPLIN MO
64804-9021
US

V. Phone/Fax

Practice location:
  • Phone: 417-626-7802
  • Fax:
Mailing address:
  • Phone: 417-540-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040226
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR15327
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: