Healthcare Provider Details

I. General information

NPI: 1639768336
Provider Name (Legal Business Name): J. KEVIN HOWARD B.S. PHARM, R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604A E SOUTH ST
OZARK MO
65721-8912
US

IV. Provider business mailing address

604A E SOUTH ST
OZARK MO
65721-8912
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-7777
  • Fax: 417-581-8152
Mailing address:
  • Phone: 417-581-7777
  • Fax: 417-581-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2019045775
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2019045775
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: