Healthcare Provider Details

I. General information

NPI: 1194787721
Provider Name (Legal Business Name): DENNIS LYNN STOCKSTILL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MCCLURG ST
RICHLAND MO
65556-9998
US

IV. Provider business mailing address

PO BOX 310 104 W. MCCLURG AVE
RICHLAND MO
65556-0310
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-3321
  • Fax: 573-765-5200
Mailing address:
  • Phone: 573-765-3321
  • Fax: 573-765-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028884
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: