Healthcare Provider Details

I. General information

NPI: 1497732077
Provider Name (Legal Business Name): ANDREW JAMES BAHL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E BROADWAY ST
MONETT MO
65708-2329
US

IV. Provider business mailing address

1873 WEST FAWN CT
MONETT MO
65708-1014
US

V. Phone/Fax

Practice location:
  • Phone: 417-235-3139
  • Fax:
Mailing address:
  • Phone: 417-236-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045001
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12612
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: