Healthcare Provider Details

I. General information

NPI: 1679554406
Provider Name (Legal Business Name): COMMUNITY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ADAMS ST
NEVADA MO
64772-3210
US

IV. Provider business mailing address

900 S ADAMS ST
NEVADA MO
64772-3210
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-6044
  • Fax: 417-667-0544
Mailing address:
  • Phone: 417-667-6044
  • Fax: 417-667-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044158
License Number StateMO

VIII. Authorized Official

Name: MRS. LORI MARIE BARTLETT
Title or Position: PHARMACIST IN CHARGE/MANAGER
Credential: R.PH
Phone: 417-667-6044