Healthcare Provider Details

I. General information

NPI: 1558289207
Provider Name (Legal Business Name): YOSKALY LAZO FERNANDEZ BPHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 UNION AVE
MOBERLY MO
65270-9449
US

IV. Provider business mailing address

513 W URBANDALE DR
MOBERLY MO
65270-1973
US

V. Phone/Fax

Practice location:
  • Phone: 660-269-3010
  • Fax:
Mailing address:
  • Phone: 660-269-3010
  • Fax: 660-269-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026019649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: