Healthcare Provider Details

I. General information

NPI: 1376838128
Provider Name (Legal Business Name): PAMELA J EAVES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54B SE 1ST LN
LAMAR MO
64759-9226
US

IV. Provider business mailing address

54B SE 1ST LN
LAMAR MO
64759-9226
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-5838
  • Fax: 417-682-5811
Mailing address:
  • Phone: 417-682-5838
  • Fax: 417-682-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42550
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: