Healthcare Provider Details

I. General information

NPI: 1497890529
Provider Name (Legal Business Name): DAUGHERTY PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 SPUR DR
MARSHFIELD MO
65706-2311
US

IV. Provider business mailing address

PO BOX 93
MARSHFIELD MO
65706
US

V. Phone/Fax

Practice location:
  • Phone: 417-468-2530
  • Fax: 417-859-7116
Mailing address:
  • Phone: 417-468-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004036066
License Number StateMO

VIII. Authorized Official

Name: JOE DAUGHERTY
Title or Position: MANAGER
Credential: RPH
Phone: 417-468-2530