Healthcare Provider Details

I. General information

NPI: 1255079729
Provider Name (Legal Business Name): NATHAN MCCARTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W MT VERNON
NIXA MO
65714
US

IV. Provider business mailing address

501 W MOUNT VERNON ST
NICA MO
65714
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-8409
  • Fax:
Mailing address:
  • Phone: 417-724-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: