Healthcare Provider Details

I. General information

NPI: 1083808349
Provider Name (Legal Business Name): DAWN B BARNES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH CENTER SUITE A
SHELBINA MO
63468
US

IV. Provider business mailing address

201 NORTH CENTER SUITE A
SHELBINA MO
63468
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-2143
  • Fax: 573-588-7545
Mailing address:
  • Phone: 573-588-2143
  • Fax: 573-588-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2007016983
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2007016983
License Number StateMO

VIII. Authorized Official

Name: DAWN B BARNES
Title or Position: PRESIDENT
Credential: RPH
Phone: 573-754-5189