Healthcare Provider Details

I. General information

NPI: 1861970816
Provider Name (Legal Business Name): MATTHEW CHARLES MCNITT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 E HINES ST
REPUBLIC MO
65738
US

IV. Provider business mailing address

4062 W REPUBLIC RD
BATTLEFIELD MO
65619-7108
US

V. Phone/Fax

Practice location:
  • Phone: 417-735-0055
  • Fax:
Mailing address:
  • Phone: 417-730-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011021454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: