Healthcare Provider Details

I. General information

NPI: 1881659126
Provider Name (Legal Business Name): GARRY BRECK BARTMESS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 EAST RICHARDSON AVE
PUXICO MO
63960
US

IV. Provider business mailing address

1701 BIG BEND RD
POPLAR BLUFF MO
63901-2916
US

V. Phone/Fax

Practice location:
  • Phone: 573-222-6206
  • Fax: 573-222-6406
Mailing address:
  • Phone: 573-718-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: