Healthcare Provider Details

I. General information

NPI: 1124628508
Provider Name (Legal Business Name): TELINA DAWN HORTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E INDEPENDENCE ST
SPRINGFIELD MO
65804-3748
US

IV. Provider business mailing address

3329 N WICKHAM CT
SPRINGFIELD MO
65803-5321
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-2645
  • Fax: 417-886-2867
Mailing address:
  • Phone: 417-860-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016026661
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: