Healthcare Provider Details

I. General information

NPI: 1225638760
Provider Name (Legal Business Name): SARAH HOFFMEISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S WESTWOOD BLVD
POPLAR BLUFF MO
63901-5519
US

IV. Provider business mailing address

211 ADELE DR
POPLAR BLUFF MO
63901-9103
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-6539
  • Fax:
Mailing address:
  • Phone: 618-317-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2018026742
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: